Morbidity and mortality after 94 extrapleural pneumonectomies for empyema

Shiraishi, Yuji; Nakajima, Yutsuki; Koyama, Akira; Takasuna, Keiichiro; Katsuragi, Naoya; Yoshida, Shuhei

doi:10.1016/s0003-4975(00)01612-x

Cited by 44 publications

(41 citation statements)

References 15 publications

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“…Shiraishi et al [19] reported that TB empyema was caused by pleural empyema due to TB infection and that the infections were from lung TB. For patients with a destroyed lung combined with empyema, especially in patients with combined BPF, closed thoracic drainage of the affected side should be performed.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Bai

Hong

Gong

et al. 2011

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Compared to the use of anti-TB drugs for the treatment of tuberculosis (TB), surgery is destructive and is associated with higher risk. Whether surgery is needed for the treatment of TB-destroyed lungs (for short: destroyed lungs) is still controversial and unresolved in the clinic. METHODS:Retrospective analysis of treatment efficacy was performed on 172 cases of destroyed lungs (176 surgeries) in the Thoracic Surgery Department of our hospital from April 1992 to June 2010. RESULTS:A total of 83 male and 89 female patients was analyzed. The youngest patient was 7 years old, and the oldest was 72 years old, with a mean age of 38.4 years. A total of 120 cases had a preoperative cough, 31 cases had fever, and 42 cases had hemoptysis. A total of 49 cases was positive for Mycobacterium tuberculosis by sputum test before surgery, yielding a positive TB rate of 28.5% (49/172). A total of 116 patients had a destroyed left lung and 56 cases had a destroyed right lung. In all, 110 cases underwent total pneumonectomy, 37 pleuropneumonectomy, one lobectomy, 10 residual lobectomy, two total pneumonectomy and tracheoplasty, 11 cases bronchopleural fistula (BPF) repair and other surgeries, and one case underwent thoracoplasty. A total of four patients underwent thoracoplasty 30 days after surgery due to a thoracic cavity infection or empyema. The overall perioperative mortality rate was 2.9% (5/172). The surgical complication rate was 18.6% (32/172). The sputum negative conversion rate was 87.8% (43/49), and the clinical cure rate was 91.9% (158/172). CONCLUSIONS:Our findings suggested that surgical treatment efficacy in destroyed lungs was satisfactory with strict surgical indications, standard preoperative anti-TB treatment, adequate preoperative preparation, and careful intraoperative operations.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Bai

Hong

Gong

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…Some authors advocate reinforcing the bronchial stump with adjacent tissues such as a pedicled pericardial fat pad, an intercostal muscle flap, or a pedicled pericardium flap. [20][21][22][23] We did not reinforce the bronchial stumps and only one patient suffered bronchopleural fistula in the current series. In our opinion, the reinforcement may be not the crux of bronchopleural fistula.…”

Section: Discussionmentioning

confidence: 71%

Analysis of Pneumonectomy for Benign Disease: A Single Institution Retrospective Study on 59 Patients

Yang

Ding

Chang

et al. 2015

ATCS

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Introduction: Pneumonectomy is the only curative treatment for some benign diseases but the operation is a challenging procedure. Herein, we present our experiences of pneumonectomy for 59 patients. Methods: The medical records of 59 patients who undergone pneumonectomy for benign lung diseases from 2008 to 2013 at the Division of Thoracic Surgery in Beijing Chest Hospital were retrospectively reviewed. Results: There were 23 male and 36 female patients. Three procedures including pneumonectomy, pleuropneumonectomy and completion pneumonectomy were used. The operative time and intraoperative blood loss were statistically different in the patients who undergone different operations. The operative time of the patients with and without tuberculosis had no difference but the intraoperative blood loss was more in the patients with tuberculosis (P = 0.035). The operative type, age and operative blood loss were relevant with the morbidity, the P value were 0.024, 0.042 and 0.027 respectively. Conclusions: Pneumonectomy for patients with benign disease may be more difficult than for patients with lung cancer, mean while pleuropneumonectomy and completion pneumonectomy may be greater challenges. But with careful patient selection and operative technique, it is a satisfactory treatment method for benign lung disease. The morbidity is acceptable and associated with operative type, age and operative blood loss.

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Section: Discussionmentioning

confidence: 99%

“…Although mortality after pleuropneumonectomy for chronic thoracic empyema is reported to be 5.4% to 8.5% (10,11), the incidence of postoperative empyema, a major complication, is now as low as 9.7% to 45.7% (10,11). In cases of fistulous empyema that develop as a result of destroyed lung, pleuropneumonectomy is indicated due to the risk of pneumonia in the contralateral lung after surgical intervention (10,11). However, because there is a high risk of complications, this procedure is not universally recommended (12) and its indication should be carefully considered (11,13 is one of the surgical indications (16).…”

Section: Discussionmentioning

confidence: 99%

“…In cases of fistulous empyema that develop as a result of destroyed lung, pleuropneumonectomy is indicated due to the risk of pneumonia in the contralateral lung after surgical intervention (10,11). However, because there is a high risk of complications, this procedure is not universally recommended (12) and its indication should be carefully considered (11,13 is one of the surgical indications (16). However, prediction of postoperative lung function is just one of the indicators; therefore, it is important to determine surgical indications after comprehensive evaluation of patients' general conditions, including their performance status (PS).…”

Section: Discussionmentioning

confidence: 99%

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Completion pneumonectomy after fenestration for empyema due to nontuberculous mycobacteriosis associated with destroyed lung as a result of cancer surgery

2017

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Long-term follow-up of post-operative lung cancer patients indicates that some patients develop lung complications. Destroyed lung cannot be ignored because it predisposes the patient to recurrent infection. We report a case of thoracic empyema with bronchopleural fistula that developed in lung tissue damaged due to cancer surgery and associated with an infection of Mycobacterium gordonae (M. gordonae); a class of bacterium responsible for nontuberculous mycobacterial infection. The patient's cancer did not recur after surgery and followed a typical course that began with sub-pleural cystitis followed by repeated infection. We performed fenestration because the patient developed fistulous empyema and the infection became difficult to control using antibiotics. The patient then underwent a radical pleuropneumonectomy and his postoperative course was excellent. Thus, in cases of impaired lung function due to cancer surgery and where pharmacologic control of infection is challenging, we suggest that radical surgical intervention should be considered.

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Morbidity and mortality after 94 extrapleural pneumonectomies for empyema

Cited by 44 publications

References 15 publications

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Analysis of Pneumonectomy for Benign Disease: A Single Institution Retrospective Study on 59 Patients

Completion pneumonectomy after fenestration for empyema due to nontuberculous mycobacteriosis associated with destroyed lung as a result of cancer surgery

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