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Comparative Study
. 2021 Oct;12(20):2710-2718.
doi: 10.1111/1759-7714.14109. Epub 2021 Aug 17.

Retrospective case-control study on the outcomes of early minimally invasive pleural lavage for pleural empyema in oncology patients

Paolo Nicola Camillo Girotti  1 , Peter Tschann  1 , Paolo Di Stefano  1 , Martin Möschel  1 , Nikolaus Hübl  1 , Ingmar Königsrainer  1
Affiliations
Comparative Study

Retrospective case-control study on the outcomes of early minimally invasive pleural lavage for pleural empyema in oncology patients

Paolo Nicola Camillo Girotti et al. Thorac Cancer. 2021 Oct.

Abstract

Background: Oncology patients carry a substantial risk of developing pleural empyema. Here, we report the preliminary results of our early video-assisted thoracoscopic surgery (VATS) lavage strategy in cases of empyema occurring in patients undergoing (radio-) chemotherapy.

Methods: This was a retrospective case-control study comparing early VATS lavage (test group, current therapy since January 2018, n = 46) versus VATS pleurectomy (historical control; before January 2018, n = 46).

Results: Five patients in the control group and one in the test group developed recurrence of empyema within 30 days. Complications were more severe and more frequently observed in the historical control group than in the test group (30/46 vs. 12/46 CI: 5%-95%, p = < 0.05). Early VATS lavage saved operating time, allowed a shorter ICU stay (2.6 days CI: 5%-95% vs. 5.1 days CI: 5%-95%, p = ns) and an earlier hospital discharge (6.1 days CI: 5%-95% vs. 13.5 days CI: 5%-95%, p < 0.05). Moreover, radio and/or chemotherapy could be reinitiated earlier (15 ± 20.5 days CI: 5%-95% vs. 40 ± 12 days CI: 5%-95%, p < 0.05).

Conclusions: In this retrospective cohort study, early VATS lavage was found to have a beneficial effect especially on hospital stay and enabling an earlier restart of radio- and/or chemotherapy.

Keywords: empyema; pleura; thoracic surgery.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Algorithm of surgical treatment in the control group (VATS pleurectomy). Phase II patients all had a chest tube drain inserted and antibiotic therapy. A VATS pleurectomy was only performed if a patient's condition worsened. Phase III patients underwent VATS pleurectomy. The open approach was reserved for cases of decortication, control of bleeding or lung surface control (adhesion). A posterolateral thoracotomy with dissection of the latissimus dorsi muscle is always proposed
FIGURE 2
FIGURE 2
Algorithm of surgical treatment in the test group (VATS lavage). Phase II patients were stratified into two different treatments arms depending on the risk factors. Phase III patients underwent the invasive surgical option. The open approach (muscle sparing mini‐thoracotomy) was reserved for cases of decortication or adhesion
FIGURE 3
FIGURE 3
(a) Empyema‐free survival was longer after VATS lavage in the test group versus the historical control (log‐rank test, p = 0.081). (b) Multivariate analysis showed a higher risk of empyema recurrence for lung and breast cancer patients. Differences did not reach statistical significance, probably due to the small cohort size
FIGURE 4
FIGURE 4
Heat map of the variables considered in the multivariate analysis. This visually highlights the correlations between all parameters considered (input at hospital admission, output at hospital discharge). Positive correlations are represented in red, and negative correlations in blue. A higher color intensity indicates a higher level of correlation
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