Up-today approaches in the surgical treatment of post-pneumonectomy empyema

Abstract

Aim: Evaluation of the different surgical techniques for the treatment of post-pneumonectomy empyema(PPE). Materials and Methods: A total of 500 patients underwent pneumonectomy between Jan 1995-Dec 2017.PPE was detected in 21(4,2%)-19 male, 2 female with an average age of 57 years. Right pneumonectomy for lung cancer(14);tuberculosis(1) and pulmonary abscess (1) was done in 16(76,19%). One(4,77%) right extra-pleural pneumonectomy for MDR tuberculosis. Four(19,04%) had left pneumonectomy for lung cancer (3) and thoracic trauma(1). Four(19,04%) received neo-adjuvant chemotherapy and seven (33,33%) adjuvant chemotherapy. Bronchial stump insufficiency(BSI) was found in 15(71,42%). Results: Palliative tube thoracostomy was applied in 2(9.5%) with late PPE and advanced malignancy. In 1(4.7%) PPE was definitively cured by tube drainage and additional irrigation. In cases of BSI were performed: accelerated treatment (Weder) with omentoplasty in 5(23.8%); open window thoracostomy(OWT) with omentoplasty(3), intercostal flap and omentoplasty(1), m.pectoralis major(1) and m.rectus abdominis(1), closed definitively (Clagett closure) within 3 months. In 1(4.7%) OWT closed spontaneously after 4 months. In 6(28.6%) recurrent VATS and our VATS modification of Weder procedure in 3 patients were carried out. The accelerated approaches and VATS provide the earliest recovery and the shortest stay. Only one of the patients had recurrent BSI and died with PPE relapse- unsuccessful application of the m. rectus abdominis. Conclusion: The treatment should be tailored for each case depending on empyema stage, presence of BSI and general condition.