Postoperative Residual Pleural Spaces: Characteristics and Natural History

Abstract

This study was conducted in order to re-define the incidence and natural history of postresectional residual pleural spaces (PRS). From 1997 to 2005, 966 patients who were subjected to less than entire lung resections, were followed and any cases of PRS were recorded. The records of these patients were retrospectively analyzed for age, gender, type of resection, side, apical or basal location, size, PRS wall thickness, empyema as well as for bronchopleural fistula occurence, management, and outcome. Postresectional residual pleural spaces outcome was correlated with space characteristics. A total of 92 cases (9.5%) of PRS were documented which developed frequently ( p < 0.001) after upper lobectomies, malignant disease, at an apical location, and on the right side. Unfavorable outcome was strongly correlated with age > 70 years ( p < 0.001), air leak ( p < 0.001), empyema ( p < 0.001), and thickened pleura ( p < 0.001). Good prognosis of PRS was strongly correlated with male gender, apical location, right side, normal pleura thickness, and small size. Postresectional residual pleural spaces of small size without any associated complications should not prolong hospitalization time.

Die pleurale Residualhöhle nach Lungenresektion

“…benigne Höhle). Prädiktoren für eine gute Prognose sind: männliches Geschlecht, kleine Höhle, apikale Lage, rechter He-mithorax und keine Pleuraverdickung [2]. In diesen Fällen ist keine prolongierte stationäre Beobachtung notwendig.…”

“…10 % der Patienten persistiert die pleurale Residualhöhle nach 12 Wochen. Risikofaktoren für ein ungünstiges Outcome sind das Alter über 70 Jahre, eine Luftleckage, die Infektion der Höhle und eine schwielige Verdickung der Pleura pulmonalis [2]. Von den Patienten mit einem postoperativen Pneumothorax entwickeln ca.…”

Pathophysiology of Extravascular Water in the Pleural Cavity and in the Lung Interstitium After Lung Thoracic Surgery

“…The "postoperative residual pleural space" refers to the fate of the volume left free by lung resection (Misthos et al, 2007). As much as in physiological conditions, the main variable setting the volume of the postoperative residual pleural space is the absorption pressure of the pleural lymphatics.…”

Tailored Thoracomyoplasty as a Valid Treatment Option for Chronic Postlobectomy Empyema

“…The incidence of a residual pleural space after lobectomy ranges from 5-21 % at discharge after removal of the chest tubes [1][2][3][4]. In more than 95% of the patients, it resoives without further treatment during follow up;…”

“…However, in 2% of the patients, infection will subsequently develop within a residual post-lobectomy space [1][2][3]5]. Prolonged air leak (> 7 days) and chest tube drainage, branchus stump insufficiency with broncho-pleural fistula, age, previous chemotherapy or irradiation and associated co-morbidity are ail implicated in the development of a postlobectomy empyema which is mainiy observed after upper lobectomy [3].…”