Video-Thoracoscopic Management of Postpneumonectomy Empyema

Galetta, Domenico; Spaggiari, Lorenzo

doi:10.1055/s-0038-1667008

Cited by 8 publications

(2 citation statements)

References 21 publications

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“…PPE treatment changes toward the most effective procedures [1,2,4,[5][6][7][8][9][10][11][12][13][14][15]17]. First described 20 years ago, accelerated treatment is currently one of the leading PPE treatment methods [1,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of cases, PPE treatment is focused on controlling the acute phase of empyema with drainage or repeated punctures of the pleural cavity, supporting the transition to the chronic phase of empyema [4]. Stabilization of the patient's metabolic, functional, and oncologic status allows the performance of a final treatment based on open-window thoracostomy, myoplasty, omentoplasty, thoracomyoplasty, accelerated treatment (AT) and videothoracoscopic (Vats) technique, vacuum-assisted closure (VAC) -therapy, or a combination of these methods [1,2,[5][6][7][8][9][10][11][12][13][14][15]. Forty years ago, a survival benefit was described among patients with lung cancer who suffered from pleural empyema compared to lung cancer patients without empyema [16].…”

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Does postpneumonectomy empyema improve long-term survival for patients with lung cancer?

Wójcik¹,

Safranow²,

Pieróg³

et al. 2022

neo

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Postpneumonectomy empyema (PPE) is life-threatening morbidity that affects up to 10% of patients and carries a 9-13% mortality risk. Treatment can take a long time, and the prognosis is uncertain. Forty years ago, improved survival was reported among patients with lung cancer and pleural empyema compared to those with lung cancer and no empyema. Here we investigated this potential association among patients with PPE. The present study included 38 patients who underwent pneumonectomy between 1995-2007 (7 females, 31 males, median age of 62 years) and then developed PPE, which was treated with the accelerated treatment (AT) method. Thirty-five of these patients had been diagnosed with lung cancer (including one case of carcinoid with infiltration), of whom 31 were matched with 31 lung cancer patients who underwent uncomplicated pneumonectomy at the same center between 1997-2009. The two groups did not significantly differ regarding sex, age, histology, TNM, FEV1, major co-morbidities, or received neoadjuvant or adjuvant therapy. Thirty-five (92.1%) patients from the initial group were treated successfully and the 5-and 10-year survival rates were 69% and 51%, respectively. Comparison between the matched groups revealed longer survival rates in the empyema group (5-year, 70%; 10-year, 49%) compared to the group without empyema (5-year, 38%; 10-year, 18%). Compared to the group without empyema, the empyema group showed significantly longer survival for all-cause mortality (p=0.004) and a lower incidence of cancerunrelated mortality (p=0.02). The two groups did not significantly differ with regard to cancer-related mortality (p=0.09). In conclusion, accelerated treatment is a safe and effective method for the treatment of pleural empyema after pneumonectomy. The presently achieved results indicate improvement in survival of lung cancer patients with PPE in comparison to lung cancer patients after uncomplicated pneumonectomy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Does postpneumonectomy empyema improve long-term survival for patients with lung cancer?

Wójcik¹,

Safranow²,

Pieróg³

et al. 2022

neo

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Postoperative Empyema After Pleurectomy Decortication for Malignant Pleural Mesothelioma

Lapidot¹,

Mazzola²,

Freyaldenhoven³

et al. 2022

The Annals of Thoracic Surgery

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Transcervical Mediastinoscopic Closure of Left-Sided Postpneumonectomy Bronchial Stump Fistula

Paleru

Cordoş

Dănăilă

et al. 2019

Thorac Cardiovasc Surg

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Introduction This article presents a series of patients on which the transcervical approach was used to close a left-sided postpneumonectomy fistula. Materials and Methods The series comprises nine patients with a left pneumonectomy performed for a tuberculosis-related suppurative disease in five cases and for lung cancer in the remaining four. This procedure can be performed under certain conditions, the most important one being the length of the bronchial stump, which should be at least 1 cm, ideally 1.5 cm. The transcervical stump closure was successfully achieved in all patients, having been more technically demanding in cancer cases with previous lymphadenectomy. The postpneumonectomy infected cavity was subsequently treated. Results The follow-up continued for at least 1 year; one individual from the cancer patients group died from an uncontrolled sepsis during the postoperative period, another one died 17 months later from metastatic cancer and two of them are alive, with no signs of neoplastic or infectious relapse 15 and 37 months, respectively, after the cervical procedure. One patient from the suppurative disease group had a relapse of the fistula 2 months after surgery, requiring additional surgical procedures to deal with this issue; all the other patients are alive, with no signs of recurrence. Conclusions The transcervical approach is a very suitable maneuver in selected patients with a bronchial stump at least 1 cm long, ideally 1.5 cm.

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Video-Thoracoscopic Management of Postpneumonectomy Empyema

Abstract: Thoracoscopy might be a valid approach for patients presenting with PPE with or without minimal BPF. Video-thoracoscopic debridement of postpneumonectomy space is an efficient method to treat PPE.

Cited by 8 publications

References 21 publications

Does postpneumonectomy empyema improve long-term survival for patients with lung cancer?

Does postpneumonectomy empyema improve long-term survival for patients with lung cancer?

Postoperative Empyema After Pleurectomy Decortication for Malignant Pleural Mesothelioma

Transcervical Mediastinoscopic Closure of Left-Sided Postpneumonectomy Bronchial Stump Fistula

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