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Ann Thorac Surg 2009;87:869-873. doi:10.1016/j.athoracsur.2008.12.003
© 2009 The Society of Thoracic Surgeons
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Fabio Massera
Mario Robustellini
Claudio Della Pona
Adriano Rizzi
Gaetano Rocco
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Original Articles: General Thoracic

Open Window Thoracostomy for Pleural Empyema Complicating Partial Lung Resection

Fabio Massera, MDa,*, Mario Robustellini, MDa, Claudio Della Pona, MDa, Gerolamo Rossi, MDa, Adriano Rizzi, MDb, Gaetano Rocco, MD, FRCS (Ed)c

a Division of General Thoracic Surgery, "E. Morelli" Regional Hospital, Sondalo, Italy
b Division of General Thoracic Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
c Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy

Accepted for publication December 1, 2008.

* Address correspondence to Dr Massera, Viale Curtatone 24, Novara, 28100, Italy (Email: fabiomassera{at}tiscalinet.it).

Background: Although an open-window thoracostomy (OWT) represents the ideal method for drainage of postpneumonectomy empyema, several controversies exist concerning its application to pleural empyema complicating pulmonary resections less than pneumonectomy.

Methods: Between January 1993 and December 2003, 19 patients (16 male and 3 female) were treated for a pleural empyema complicating partial lung resection. The median age was 62 years (range, 17 to 79). Five patients (26%) had a bronchopleural fistula.

Results: In 2 patients (10%), successful control of the infection was achieved with the OWT. In 10 patients (56%), the OWT was closed by obliteration of pleural cavity with antibiotic solution (2 patients) or intrathoracic muscle transposition (8 patients). OWT closure was successfully performed in all of 5 patients with postoperative pleural empyema due to bronchopleural fistula. Prolonged chest drainage was not successful in any patient with late onset postoperative pleural empyema. Univariate analysis revealed that previous left pulmonary resections (p < 0.05) and timing of OWT (p < 0.001) were significant predictors of empyema healing after pulmonary resections smaller than pneumonectomy.

Conclusions: Immediate OWT is a significant predictor of empyema healing after partial lung resection. Smaller pleural cavities appeared to increase the likelihood of healing. Prolonged chest tube drainage failed to control the infection in late onset of postoperative pleural empyema due to entrapped lung.


Related Article

Invited commentary.

Ann. Thorac. Surg. 87: 873-874. [Full Text]



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K. A. Mansour
Invited commentary.
Ann. Thorac. Surg., March 1, 2009; 87(3): 873 - 874.
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