Accelerated treatment for early and late postpneumonectomy empyema

Background. Postpneumonectomy empyema is a rare but serious complication of pneumonectomy. Despite use of various therapeutic approaches and technique s during the last five decades, successful therapy remains difficult and is often associated with high morbidity and prolonged hospitalization. Methods. We evaluated a concept for accelerated treatment, which consists o f radical debridement of the pleural cavity and packing with wet dressings of povidone-iodine. This was repeated in the operating theater every second day, until the chest cavity was macroscopically clean. If present, bronchi al stump insufficiency was closed and secured by omentopexy. Finally, the p leural space was obliterated with antibiotic solution. Results. Twenty patients, 13 with early postpneumonectomy empyema (10 to 89 days; mean, 37 days) and 7 with late postpneumonectomy empyema (124 to 7,2 00 days; mean, 1,126 days) were treated. Fifteen patients presented with br onchopleural fistula (11 right, 4 left), which developed after chemotherapy (n = 6) or after radiotherapy (n = 3) (unknown cause in 4 patients). Six p atients were referred after previously unsuccessful surgical attempts. Pleu ral cultures were positive in 17 cases for one or several bacteria includin g fungoides (n = 2). The average number of interventions was 3.5 (3 to 5). The chest was definitively closed in all patients within 8 days. Mean hospi talization time was 17 days (7 to 35 days). During the same hospitalization , 2 patients needed reoperation because of an undetected bronchopleural fis tula. Postpneumonectomy empyema was successfully treated in all patients. T here was no in-hospital or 3-month postoperative mortality. Conclusions. Repeated surgical debridement combined with closure of broncho pleural fistula and antimicrobial therapy enables successful treatment of e arly and late postpneumonectomy empyema within a short period and is a well -tolerated concept. (C) 2001 by The Society of Thoracic Surgeons.