The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients—a single-center experience and literature review

Abstract

Background Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review. Methods We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of “A. Cardarelli” Hospital, in Campobasso, Molise, Italy. Results A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as “adults,” 14 (48.28%) patients were older than 70 years old, identified as “elderly.” No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery. Conclusion In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients.

Optimal Timing for Video-Assisted Thoracic Surgery Decortication in Chronic Empyema: A survival analysis

“…Matsudaira et al reported VATS timing for acute pyothorax but no speci c phase (19). For phase-speci c studies, such as the study by Luciani et al on uniportal VATS in the treatment of stage II pleural empyema, "surgery at days after admission" was used to standardize treatment timing (20). Similarly, for our particular group and focus, we choose a more speci c and objective index -duration to surgery since admission day.…”

Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation

“…Another key point is absence of a systematic classification that includes BDTT as a prognostic factor. These two points do not allow clinicians to appropriately relate BDTT to a stage of HCC; however, surgical treatment appears to be the first treatment option [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Considering the undeniable benefits of minimally invasive surgery, we have to underline that it offers a safer surgical approach for patients with a Performance Status (PS) of 1 or 2, allowing a shorter length of stay and faster recovery which as show a great impact also in patients undergoing surgical downstaging [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

Artificial Intelligence to Early Predict Liver Metastases in Patients with Colorectal Cancer: Current Status and Future Prospectives

“…In a recent meta-analysis, Komici et al [102] evaluated the prevalence and impact of frailty in HPB surgery: Frailty was found in about 40% of patients affected by liver cancer, including CRLM. Indeed, comorbidities and frailty should be managed in elderly patients to predict inter-individual variability [103,104]. It is a crucial point: an early detection of CRLM could improve long-term outcomes in this subset of patients, considering the mortality rate reported for major hepatectomies [71,105].. Future perspectives are linked to AI applications to predict liver failure or future liver remnants in the preoperative evaluation of patients affected by huge liver tumors [106,107].…”