Didier Schneiter1, Tomasz Grodzki2, Didier Lardinois1, Peter B. Kestenholz1, Janusz Wojcik2, Bartosz Kubisa2, Jaroslaw Pierog2, Walter Weder1; 1Thoracic Surgery University Hospital of Zurich, Zurich, Switzerland; 2Thoracic Surgery, Szczecin, Poland
Objective: Postpneumonectomy empyema (PPE) remains a clinical challenge. We proposed an accelerated therapy without fenestration of the chest 5 years ago. This concept was now evaluated in a larger scale in two centres in two different countries.Methods: Between March 1995 and July 2006 74 consecutive patients with PPE were treated in Szczecin (Poland) (35) and Zurich (Switzerland) (39). The therapy consisted in repeated thoracotomies with surgical debridement of the pleural cavity under general anaesthesia every second day until the chest cavity shows macroscopic clean granulation tissue. In between the chest was filled with towels soaked in povidone-iodine. If present, broncho-pleural fistula (BPF) was closed and reinforced either by a muscle-flap or the omentum. Finally the pleural space was obliterated with antibiotic/antimycotic solution and the chest closed. Systemic antibiotic/fungal therapy was given for additional two weeks.
Results: Out of 74 Patients (63 men, median age 59 years (range 19-82)) PPE was present on the right in 46 patients (32 with bronchial stump insufficiency (BSI)) and in 28 patients on the left side (12 BSI). Median time between pneumonectomy and PPE was 131 days (7-7200 days). All BSI have been reinforced by different methods (omentum 18, muscle 16, pericardial fat 10). Within 8 days the chest was definitively closed in all patients except in two (12 an 13 days). Median hospitalisation time was 18 days (9-134 days). PPE was successfully treated in all but four patients (94% success rate). In five patients the empyema recurred at 47, 49, 71, 101, 105 days after the first episode and the procedure was repeated with success. Two patients (2.7%) died during hospital stay on day 25 and 81 respectively (SIRS and pulmonary embolism). Median follow-up time was 36 moths (2-120 months).
Conclusion: Treatment of PPE by the accelerated concept is safe and effective. Results are better then in reported series using a (temporary) chest fenestration. Patients highly appreciate the physical integrity of the chest.
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