Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis

Background: Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet. Methods: We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared. Results: The mean age(+/- standard deviation) of 11 men and 4 women in group A was 58.2 +/- 15.7 years, and of 9 men and 2 women in group B was 51.6 +/- 9.5 years. Group B had a significantly shorter hospital stay (16.6 +/- 7.4 vs. 33.7 +/- 22.6 days; p=0.014), shorter chest tube duration (10.5 +/- 5.7 vs. 19.5 +/- 14.4 days; p=0.039), shorter leukocytosis duration (6.7 +/- 6.5 vs. 18.8 +/- 13.2 days; p=0.008), shorter febrile duration (0.8 +/- 1.8 vs. 9.4 +/- 9.2 days; p=0.004), and shorter duration of intravenous antibiotics usage (14.9 +/- 6.4 vs. 25.4 +/- 13.9 days; p=0.018). However, radiological improvements did not show any statistical differences. Conclusion: Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.