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Ann Thorac Surg 2000;70:1202-1206
© 2000 The Society of Thoracic Surgeons
a Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan
Address reprint requests to Dr Shiraishi, Section of Chest Surgery, Fukujuji Hospital, 3–1-24 Matsuyama, Kiyose, Tokyo, 204–8522 Japan;
e-mail: yujishi{at}mvb.biglobe.ne.jp
Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
Background. Extrapleural pneumonectomy is still indicated in some patients with empyema. We examined morbidity and mortality after this high-risk operation.
Methods. Between 1979 and 1998, 94 (92 chronic, 2 postsurgical) patients with empyema underwent extrapleural pneumonectomy. There were 79 men and 15 women (mean age, 59 years). Eighty-eight patients had a history of tuberculosis, and 53 had undergone a therapeutic pneumothorax. The right side was operated on in 50 patients and left in 44.
Results. Operative mortality was 8.5%. Fifteen major complications (1 esophageal perforation, 9 empyemas, and 5 bronchopleural fistulas) occurred in 13 patients. Eight patients required reexploration for hemorrhage. Reexploration was a risk factor for empyema. Bronchopleural fistulas occurred only on the right side. Eighty-nine percent of the 86 operative survivors were free of empyemas at 5 years. Overall 5-year survival was 83%, and survival was better in patients without than in those with empyema.
Conclusions. Extrapleural pneumonectomy for empyema has acceptable morbidity and mortality. Postoperative empyema affects prognosis. Covering a bronchial stump with muscle is recommended, especially when the operation is performed on the right side.
Related Article
Ann. Thorac. Surg. 2000 70: 1206-1207.
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