Surgical treatment of pleural empyema: our observations and global trends
DOI:
https://doi.org/10.5281/zenodo.14769998Keywords:
pleural empyema, thoracotomy, VATS, thoracic surgeryAbstract
Background: The importance of issues related to the diagnosis and treatment of pleural empyema has significantly increased in recent years, considering the severity of the disease, high mortality, and widespread antibiotic resistance. Late referral to specialized surgical clinics complicates operative treatment, limits the possibilities of minimally invasive technologies applying, and worsens the prognosis for these patients.
Materials and methods: The article conducts a retrospective analysis for the period between December 2022 and 2023, describing the experience of the Department of Thoracic Surgery, University Multiprofile Hospital for Active Treatment "N.I. Pirogov," in the operative treatment of patients admitted with stage II and III pleural empyema.
The percentage ratio between videoassisted thoracoscopic interventions and thoracotomies, the number of conversions, average length of hospital stay, and overall mortality are evaluated. The most commonly isolated bacterial pathogens and their antibiotic sensitivity are described. A brief literature review on the topic is conducted.
Results: Over 60% of patients admitted to the clinic had chronic empyema in the stage of organization. The main etiological cause was pneumonia complicated by parapneumonic pleural effusion with development of pyothorax. Massive adhesions due to chronic inflammatory process is a main reason for a high conversion rate (36%) and high percentage of thoracotomies (43%), compared to thoracoscopic interventions (VATS) performed in 21% of cases. Mortality among operated patients reaches 21.4%. Polyresistant bacterial strains are predominantly isolated as causative agents, which is most likely associated with prolonged preoperative antibiotic therapy, and which is significantly complicating the choice of an effective treatment in the postoperative period.
Satisfactory expansion of the lung parenchyma and improvement in respiratory function are noted in all discharged patients.
Conclusion: Pleural empyema is a challenging pathology in thoracic surgery associated with high mortality. Despite the globally proven effectiveness of VATS in treating pleural empyema, according to our clinic's experience, thoracotomy with decortication often remains a safer and more effective approach for patients with evidence of chronisation of the inflammatory process and organization.
References
1. [Drobyazgin E.A., Chikinev Yu.V., Shcherbina K.I. Valve bronchoblockade in the treatment of bronchopleural fistulas, ActaBiomedicaScientifica, 2017; 118(6):110-113.]. Дробязгин Е.А., Чикинев Ю.В., Щербина К.И. Клапанная бронхоблокация при лечении бронхоплевральных свищей, ActaBiomedicaScientifica, 2017; 118(6):110-113.
2. Abraham SV, Chikkahonnaiah P. Change in Pulmonary Function Following Decortication for Chronic Pleural Empyema. Turk Thorac J. 2020;21(1):27-31.
3. BagheriR, Houra M, Saberi-KarimianMet al. The Effects of Glubran Glue on Alveolar Air Leak in Patients with Chronic Empyema. Journal of Cardio-Thoracic Medicine 2022;10(1):925-930.
4. Bobbio А, BouamS, Frenkiel J et al. Epidemiology and prognostic factors of pleural empyema. Thorax 2021;76(11):1117-1123
5. Bertolaccini L, Lybéris P, Manno E. Lung sealant and morbidity after pleural decortication: a prospective randomized, blinded study. J Cardiothorac Surg. 2010;45(5):1-4.
6. Betz V, van Ackeren V, Scharsack E et al. Intrathoracic negative pressure therapy for pleural empyema using an open-pore drainage film. Chirurgie 2023;94:530–543.
7. Chan K-PF, Ma T-F, Sridhar S et al. Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic. Microorganisms 2023;11(2):303.
8. D'Ambrosio PD, Araujo PHXN de, Rocha Junior E et al. Risk factors related to pleural empyema after talc slurry pleurodesis. Clinics 2022;77:100098.
9. Federici S, Bédat B, Hayau J et al. Outcome of parapneumonic empyema managed surgically or by fibrinolysis: a multicenter study. J Thorac Dis. 2021;13(11):6381-6389.
10. Fruchter O, El Raouf BA, Abdel-Rahman N, Saute M, Bruckheimer E, Kramer MR. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up. Respiration 2014;87(3):227–33.
11. Haberal MA, Akar E, Şengören Dikiş Ö et al. Effectiveness of the polyglycolic acid patch in preventing prolonged air leakage after pulmonary decortication. ANZ Journal of surgery 2022;92(7-8):1845-1849.
12. Hafidi S, Boubia S, Fatene A et al. Prognostic factors influencing the outcome of empyema surgical management: prospective study in a Moroccan university center. British Journal Of Surgical Science 2021; 1(1)
13. Hasegawa K, Toriyama A, Nomizo T et al. Bilateral pleural empyema by Enterobacter infection secondary to pancreaticopleural fistula. Clin Case Rep. 2020;8:3327–3331.
14. Hekimoglu B, Beyoglu MA Pleural empyema management: The impact of Video-assisted thoracoscopic surger. Medicine Science 2022;11(4):1467-72.
15. IraniL, Aryankhesal A, Alipour V. Comparison of video assisted thoracoscopic surgery with thoracotomy for treatment of chronic empyema: a systematic review study. Health Technology Assessment in Action 2020;4(3):1-9.
16. Ing LY, Arif M. Is Video-Assisted Thoracoscopic Surgical Decortication Possible for Stage III Pleural Empyema? Sch J App Med Sci. 2021;9(4):541- 545
17. Jindal R, Nar AS, Mishra A et al. Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema: A comparative study. J Minim Access Surg. 2021; 17(4):470–478.
18. Kawabata T, Ikeda M, Matsuzoe H et al. Acute Pleural Empyema Secondary to COVID-19 Treated with Negative-Pressure Wound Therapy, Resulting in Good Lung Expansion and Early Wound Closure. International Journal of Surgical Wound Care 2023;4(1):22-28.
19. Kheir F, Thakore S, Mehta H et al. Intrapleural Fibrinolytic Therapy versus Early Medical Thoracoscopy for Treatment of Pleural Infection. Randomized Controlled Clinical Trial. Annals of the American Thoracic Society 2020;17(8):958-964.
20. Kumar A, Lingaraju CV, Pulle MV et al. Comparison of outcome of surgery for tubercular and nontubercular empyema: An analysis of 285 consecutive cases. Lung India 2021;38(6):514–519.
21. Lampridis S, Mitsos S, Lawrence DR et al. Lung Decortication With Argon Plasma Energy for the Treatment of Chronic Pleural Empyema. Innovations 2021;16(4):386-389.
22. Lee EJ, Lee KH, Kim JH et al. A CARE-compliant article: a case report of pleural empyema secondary to Klebsiella pneumoniae liver abscess with a hepatopleural fistula. Medicine (Baltimore) 2020;99(16):e19869.
23. Luciani C, Scacchi A, Vaschetti R et al. The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients—a single-center experience and literature review. World J Emerg Surg. 2022;17(46).
24. Maddocks S, Fabijan AP, Ho J et al. Bacteriophage Therapy of Ventilator-associated Pneumonia and Empyema Caused by Pseudomonas aeruginosa. American Journal of Respiratory and Critical Care Medicine 2019;200(9):1179-81.
25. Majeed FA, Chatha SS, Zafar U et al. Surgical management of paediatric empyema: open thoracotomy versus video-assisted thoracic surgery. J Coll Physicians Surg Pak. 2020;30(3):309-312.
26. Mohajerzadeh L, Lotfollahzadeh S, Vosoughi A et al. Thoracotomy versus Video-Assisted Thoracoscopy in Pediatric Empyema. Korean J Thorac Cardiovasc Surg. 2019;52(3):125-130.
27. Muharrem C, EvrimG. Surgical approaches in patients with empyema: Clinical evaluation. The Annals of Clinical and Analytical Medicine. The Annals of Clinical and Analytical Medicine 2020;1(4):291-296.
28. Mummadi SR, Stoller JK, Lopez R et al. Epidemiology of Adult Pleural Disease in the United States. Thoracic Oncology: Original Research 2021;160(4):1534-1551.
29. Nishii K, Nakajima T, Yamamoto T et al. Management of thoracic empyema with broncho-pulmonary fistula in combination with negative-pressure wound therapy. Gen Thorac Cardiovasc Surg. 2021;69:843–849.
30. Pilav I, Alihodzic-Pasalic A, Musanovic S et al. Efficacy of Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Primary Pleural Empyema. Acta Inform Med. 2020; 28(4):261–264.
31. Polyakov IS, Kovalenko AL, Petrovsky AN et al. The rare thoracic complication: perforation of gastric fundus ulcer: a case report. J Med Case Reports 2022;16:472.
32. Puskas JD, Mathisen DJ, Grillo HC et al. Treatment strategies for bronchopleural fistula. The Journal of Thoracic and Cardiovascular Surgery 1995;109(5):989-996.
33. Ricciardi S, Giovanniello D, Carleo F et al. Which Surgery for Stage II–III Empyema Patients? Observational Single-Center Cohort Study of 719 Consecutive Patients. Journal of Clinical Medicine 2023;12(1):136.
34. Santana-Rodríguez N, Aldebakey H, Albalkhi I et al. Surgical management of parapneumonic empyema. Shanghai Chest 2022;6:25.
35. Stüben BO, Plitzko GA, Sauerbeck J et al. Minimally invasive intrathoracic negative-pressure therapy and flexible thoracoscopy (FlexVATS) for patients with pleural empyema. Sci Rep. 2023;13:10869.
36. Tawfek A, Elsharawy M, Ibrahim M et al. Results of two fibrinolytics in treatment of the early stage of empyema. Zagazig University Medical Journal 2023;29(1):120-126.
37. Tufano A, Minelli R, Di Lascio G et al. Infected kidney stone progressing to perinephric abscess and thoracic empyema. Archivio Italiano Di Urologia E Andrologia 2020;92(3):203-204.
38. Varadhan AK, Parikh NS, Parvathaneni S et al. Multiple Episodes of Right Pleural Empyema Due to Different Bacterial Pathogens Successfully Treated with Repeated Modified Clagett Procedures. American Journal of Surgery Case Reports 2021;2:1017.
39. Yokoyama Y, Kuno T, Takagi H et al. Choice of intrapleural fibrinolytic agents in the treatment of adult complicated parapneumonic effusion and empyema: Network meta-analysis. Asian Cardiovascular and Thoracic Annals 2023;31(5):451-458.
40. Yang YH. Surgical Challenges of Chronic Empyema and Bronchopleural Fistula. Pleura - A Surgical Perspective 2022. Available from: http://dx.doi.org/10.5772/intechopen.100313.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 S. Sopotenski, Iryna Lytvynenko, S. Petrov (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
