Objective: The role of thoracic surgery in patients with acquired immu
nodeficiency syndrome (AIDS) continues to evolve, This review seeks to
evaluate the outcome, morbidity, and mortality associated with video-
assisted thoracoscopic surgery for empyema and pneumothorax in patient
s with AIDS, Methods: A retrospective review was conducted of patients
with AIDS in whom video-assisted thoracoscopic surgery was performed
for empyema (group 1) or intractable pneumothorax (group 2), Results:
Twenty patients with AIDS (95% male, mean age 37.4 years, mean CD4 cou
nt 76 cells/ml(3)) underwent thoracoscopy, Surgery was performed for e
mpyema (group 1) in 11 (55%) and intractable pneumothorax (group 2) in
nine (45%), Three patients (15%) died within 30 days of the operation
, At mean follow-up (29 months), overall survival was 55%, For those w
ho survived the hospitalization and died within the follow-up period (
35.3%), mean survival time was 8.2 months (range 1 month to 27 months)
, In group 1, surgical procedures were performed after 8 days of chest
tube drainage and included pleural debridement and mechanical pleurod
esis (n = 11) along with lung biopsy (n = 6), Survivals at 30 days and
29 months' follow-up were 90.9% and 45.4%, respectively, In group 2,
significantly depressed CD4 counts (average 33.2 cells/ml(3)) were not
ed along with a more prolonged preoperative hospitalization (18.5 days
) with 14.2 days spent with a chest tube before the operation, In this
group, operative procedures included mechanical pleurodesis and talc
poudrage (n = 9), bleb resection (n = 7), and lung biopsy (n = 1), Two
deaths (22%) occurred within 30 days of the operation and survival at
29 months' follow-up was 66%, Conclusion: Video-assisted thoracoscopi
c surgery performed in patients with AIDS for the treatment of empyema
and intractable pneumothorax is effective, can be performed with litt
le operative morbidity and mortality, and is associated with acceptabl
e long-term survival, Video-assisted thoracoscopic surgery is best per
formed soon after the diagnosis of intractable pneumothorax or empyema
has been established.