Long-term outcomes and risk factors of residual thoracic spaces after pleurectomy/decortication for mesothelioma

Abstract

OBJECTIVES The residual thoracic spaces (RTS) after pleurectomy/decortication (P/D) remain unexplored to date. Hence, this study aims to examine the details and risk factors of RTS during the 3 post-P/D months. METHODS We retrospectively examined patients who underwent neoadjuvant chemotherapy, followed by P/D for malignant pleural mesothelioma from September 2012 to December 2020. The RTS group included cases of residual thoracic cavity unaccompanied by pleural effusion on 3 postoperative months computed tomography. We determined risk factors for RTS using univariable and multivariable analyses. RESULTS Of 170 patients examined, 58 (34.1%) were in the RTS group and 112 (65.9%) in the non-RTS group. In the RTS group, 43 patients recovered from RTS during the follow-up period; 4 patients developed chronic fistular empyema, while 2 required fenestration and 2 were thoracoscopic debridement. Besides, 11 patients exhibited RTS continuously. The univariable analysis revealed that compared with the non-RTS group, the RTS group reported a significantly longer postoperative air leak (>7 days; P <0.01) and right P/D (P =0.04). The multivariable analysis demonstrated that longer postoperative air leak (>7 days) remained a risk factor for RTS (odds ratio 2.5, 95% confidence interval: 1.3–4.9, P < 0.01). CONCLUSIONS RTS was a postoperative event that frequently observed in patients undergoing P/D. Overall, the current study findings suggest longer postoperative air leak (>7 days) as a significant risk factor for RTS.

A case of attempted transbronchial spigot insertion for fistulous pyothorax in the residual pleural airspace after pleurectomy/decortication for malignant pleural mesothelioma

“…3 Prolonged air leakage is correlated with RTS and postoperative empyema. 3 Herein, we report a case of attempted transbronchial spigot insertion for fistulous pyothorax in RTS after P/D for MPM. During attempted transbronchial occlusion of the responsible bronchus, some spigots penetrated the empyema cavity, and open window thoracotomy was performed on the following day.…”

“…3 The incident rate of residual thoracic airspace (RTS) after P/D is reported to be 34%, but this mostly disappears spontaneously during the follow-up period. 3 Prolonged air leakage is correlated with RTS and postoperative empyema. 3 Herein, we report a case of attempted transbronchial spigot insertion for fistulous pyothorax in RTS after P/D for MPM.…”

“…A major complication unique to P/D is postoperative air leak, which can result in empyema or pneumonitis. Broncho‐ or pulmonary‐pleural fistula from decorticated lung allows residual airspace without pleural effusion to persist for an extended period 3 . The incident rate of residual thoracic airspace (RTS) after P/D is reported to be 34%, but this mostly disappears spontaneously during the follow‐up period 3 .…”

“…Broncho‐ or pulmonary‐pleural fistula from decorticated lung allows residual airspace without pleural effusion to persist for an extended period 3 . The incident rate of residual thoracic airspace (RTS) after P/D is reported to be 34%, but this mostly disappears spontaneously during the follow‐up period 3 . Prolonged air leakage is correlated with RTS and postoperative empyema 3 …”

“… 3 The incident rate of residual thoracic airspace (RTS) after P/D is reported to be 34%, but this mostly disappears spontaneously during the follow‐up period. 3 Prolonged air leakage is correlated with RTS and postoperative empyema. 3 …”