Purulent pleurisy and lung cancer: non-iatrogenic forms therapeutic management

Thoracic empyemas may occur during the course of lung cancer as a post-thor acotomy complication, or after pleural drainage and/or chemotherapy in case s when surgery was unfeasible, or may complicate the natural history of the disease and appear as the clinical event that led to its discovery. This l atter situation is a challenge requiring to dire the infection in order to further treat the underlying lung cancer. We reviewed the cases of 18 men aged between 46 and 79 years that referred to our surgical department from 1984 to 1996 for management of a thoracic e mpyema with an underlying lung cancer Initial presentation of empyemas, lun g tumor characteristics, treatments performed and their results were analyz ed so as to formulate guidelines if possible. Mean duration of 17 empyemas before arrival was 26 days 18 to 60 days) and in one case empyema occurred during diagnostic work-up of an excavated lesi on. Frank pus was observed in all cases and micro-organisms were identified in 13 cases. Empyema and diagnosis of lung cancer were concomitant in 15 c ases: in 3 cases lung neoplasia was already diagnosed but patients had refu sed surgery. Empyema was treated by under water-seal chest tube drainage wi th adjunct fibrinolytic therapy in all cases; 2 elderly and cachectic patie nts suffering metastatic diffusion? died rapidly. The other 16 recovered wi thin one month. In 7 cases management was limited to medical treatment (pal liative n = 2, chemotherapy n = 1, chemo combined radiotherapy n = 2 and ra diotherapy alone n = 21 but only short survivals were observed (inferior to 10 months). Surgery was possible in 9 (pneumonectomy n = 8, lobectomy n = I); there,was no death; postsurgical empyemas complicated the cause twice b ur were easily cured by drainage; long term survivals were observed ed ba 3 cases that were p NO. Pleural empyema complicating lung cancer is a rare b ut challenging situation. Once the pleural empyema has been controlled, sur gical resection must be performed when indicated: postoperative complicatio ns are rare long-term survival is possible.