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. 2000 Oct;70(4):1202-6; discussion 1206-7.
doi: 10.1016/s0003-4975(00)01612-x.

Morbidity and mortality after 94 extrapleural pneumonectomies for empyema

Y Shiraishi  1 , Y Nakajima, A Koyama, K Takasuna, N Katsuragi, S Yoshida
Affiliations

Morbidity and mortality after 94 extrapleural pneumonectomies for empyema

Y Shiraishi et al. Ann Thorac Surg. 2000 Oct.

Abstract

Background: Extrapleural pneumonectomy is still indicated in some patients with empyema. We examined morbidity and mortality after this high-risk operation.

Methods: Between 1979 and 1998, 94 (92 chronic, 2 postsurgical) patients with empyema underwent extrapleural pneumonectomy. There were 79 men and 15 women (mean age, 59 years). Eighty-eight patients had a history of tuberculosis, and 53 had undergone a therapeutic pneumothorax. The right side was operated on in 50 patients and left in 44.

Results: Operative mortality was 8.5%. Fifteen major complications (1 esophageal perforation, 9 empyemas, and 5 bronchopleural fistulas) occurred in 13 patients. Eight patients required reexploration for hemorrhage. Reexploration was a risk factor for empyema. Bronchopleural fistulas occurred only on the right side. Eighty-nine percent of the 86 operative survivors were free of empyemas at 5 years. Overall 5-year survival was 83%, and survival was better in patients without than in those with empyema.

Conclusions: Extrapleural pneumonectomy for empyema has acceptable morbidity and mortality. Postoperative empyema affects prognosis. Covering a bronchial stump with muscle is recommended, especially when the operation is performed on the right side.

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