Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication

• Published in: European journal of cardio-thoracic surgery 2009-11, Vol.36 (5), p.914-918
• Main Authors: Cardillo, Giuseppe, Carleo, Francesco, Carbone, Luigi, Di Martino, Marco, Salvadori, Lorenzo, Petrella, Lea, Martelli, Massimo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Charrier; Chronic Disease; Empyema; Empyema, Pleural - etiology; Empyema, Pleural - surgery; Female; Humans; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Pleural diseases; Pneumology; Pneumonia - complications; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - methods; Thoracoscopic surgery; Thoracotomy - adverse effects; Thoracotomy - methods; VATS; video-assisted-thoracoscopy; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.06.017

Objective: We seek to evaluate the comparative merits of thoracoscopic versus open decortication in the surgical management of patients with chronic postpneumonic pleural empyema. Methods: From January 1996 to December 2006, 308 patients (180 males, 128 females, mean age: 56.3 years, range: 17–82 years) with chronic postpneumonic pleural empyema underwent decortication after failure of conservative treatment. Results: Decortication was performed by open thoracotomy in 123 (39.9%) patients (OT) and by videothoracoscopy (VT) in 185 (60.1%). Mortality was 1.29% (4/308). Morbidity was 21.1% (65/308). At 6 months follow-up, three VT patients showed recurrent empyema and underwent re-do surgery by video-assisted-thoracoscopy (VATS) (one patient) or by thoracotomy (two patients). The videothoracoscopic approach showed statistically significant better results in terms of in-hospital postoperative (day 1 and day 7), pain (p ≪ 0.0001), postoperative air leak (p = 0.004), operative time (p ≪ 0.0001), hospital stay (p = 0.020) and time to return to work (p ≪ 0.0001). The analysis of postoperative pain at 6 months follow-up showed no significant differences among the different groups. Conclusions: In the light of our experience, videothoracoscopic decortication appears to be the surgical treatment of choice for chronic postpneumonic pleural empyema even if a multicentric-randomised trial should be performed before videothoracoscopic decortication becomes the gold standard for the treatment of pleural empyema.