Management of postpneumonectomy empyema and bronchopleural fistula

Abstract

: Although the number of pneumonectomies performed worldwide is decreasing due to epidemiological changes in lung cancer, increased awareness of postoperative complications of pneumonectomy plays a major role in the proper clinical management and ultimately in the quality of life and survival rate of patients. Postpneumonectomy empyema is a rare but serious complication of pneumonectomy. The prognosis of postpneumonectomy empyema patients mainly depends on when the complication appears and the presence or absence of a bronchopleural fistula (BPF). The majority of empyema will occur within the first 3 months after surgery. The management of postpneumonectomy empyema is a challenge to thoracic surgeons due to the number of surgical approaches available and a lack of consensus as to the best approach. It can vary from a simple rib resection and open drainage to a complete thoracoplasty. Unfortunately, after pneumonectomy, patients who develop BPF and empyema will present prolonged hospitalization and are at risk of high morbidity and mortality rates. Consequently, successful therapy might be difficult to achieve, that is why is so important to well select your strategy. Though this remains an area of controversy in the field of thoracic surgery, accurate and expedited diagnosis is critical to achieve a cure. Regardless of the technique adopted for treatment, adequate pleural drainage, definitive closure of the BPF, sterilization of the pleural cavity, and obliteration of residual space are the key factors to favorable outcomes. In this article, the authors aim to discuss in detail the management strategy based on the clinical evolution of patients with postpneumonectomy empyema and BPF.