Video-Thoracoscopic Management of Postpneumonectomy Empyema

Background Postpneumonectomy empyema ( PPE) is a serious complication even when it is not associated with bronchopleural fistula ( BPF). Besides irrigation, an aggressive treatment is usually applied for removing infected material. However, a minimally invasive approach might achieve satisfactory results in selected patients. Methods We retrospectively identified 18 patients presenting with PPE receiving video- thoracoscopic approach. Of these 18 patients, pneumonectomy was performed for nonsmall cell lung cancer in 15 cases, for mesothelioma in 2, and for trauma in 1 case. There were 14 males and 4 females, ( mean age, 62 years; range, 44- 73 days). Empyema was confirmed by thoracentesis and bacteriological examination. All patients had immediate chest tube drainage and underwent thoracoscopic debridement of the empyema. Fifteen patients had no proven BPF; two had suspicious BPF, and one had a minor (< 3 mm) BPF. Results Median time frompneumonectomy to empyema diagnosis was 129 days ( range, 7- 6205 days). Median time from drain position to video- assisted thoracoscopic surgery ( VATS) procedure was 10 days ( range, 2- 78 days). A bacterium was isolated in 13 cases ( 72.2%). There was no mortality and no morbidity related to the procedure. The average duration of thoracoscopic debridement was 56 minutes ( range, 40- 90 minutes). Median postoperative stay was 7 days ( range, 6- 18 days). Only in one patient an open- window thoracostomy was performed. Median follow- up of the 18 patients receiving thoracoscopy was 41.5 months ( range, 1- 78 months). None had recurrent empyema. The patient with a minor BPF remained asymptomatic and is doing well at 48 months follow- up. Conclusions Thoracoscopy might be a valid approach for patients presenting with PPE with or without minimal BPF. Video- thoracoscopic debridement of postpneumonectomy space is an efficient method to treat PPE.