Postpneumonectomy Empyema: Results After the Clagett Procedure

Zaheer, Salman; Allen, Mark S.; Cassivi, Stephen D.; Nichols, Francis C.; Johnson, C. H.; Deschamps, Claude; Pairolero, Peter C.

doi:10.1016/j.athoracsur.2006.01.052

Cited by 117 publications

(78 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, treatment varies depending upon the phase of PPE, presence or absence of BPF, general patient condition, oncologic status and experience of the surgical team [1][2][3][4][5][6][7][11][12][13][14]. Today, the most popular treatment is combined open window thoracostomy with partial thoracoplasty and intrathoracic muscle transposition.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Accelerated treatment of postpneumonectomy empyema – report of 12-year experience

Wójcik

Grodzki²,

Kubisa³

et al. 2012

neo

View full text Add to dashboard Cite

We report 12-year experience in the accelerated treatment (AT) of postpneumonectomy empyema (PPE). There were 38 patients (7 females, 31 males) in age 19-80 years. 34 patients underwent pneumonectomy due to non-small cell lung cancer (NSCLC), 2 for other malignancies, and 2 for lung abscess. 19 right and 19 left pneumonectomies were performed. PPE was caused by bronchopleural fistula in 16 cases (42.1%) and by pleural infection in 22 patients (57.9%). The interval between first symptoms of PPE and AT ranged 1-47 months. The technique described by Schneiter et al. is based on repeated debridement/lavage of the postpneumonectomy cavity every second day performed a total of three times. 35 patients (92.1%) were free from empyema definitively. 4 of them required additional thoracomyoplasty and another 2 of them thoracostomy due to PPE recurrence. 1 patient (2,6%) died during hospitalisation and 2 (5.2%) didn't complete treatment and remained drain carriers. AT alone without additional procedures healed 29 patients (76.3%). Follow up time for the NSCLC group was 8-148 months (median 67). Cancer recurrence or second malignancy rate was 8/36 (22%). Accelerated treatment of PPE is safe and effective. It provides cure for the vast majority of patients without thoracoplasty. Patients with cancer and PPE tend to live longer than similar patients without PPE.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Chest tube drainage is the most frequent mode of treatment for the acute phase of PPE. The chronic phase of PPE (including BPF) usually requires complicated and time-consuming treatment [1][2][3][4][5][6]. Since 1998, accelerated treatment [AT] has been applied in the Thoracic Surgery Department in Szczecin.…”

mentioning

confidence: 99%

Accelerated treatment of postpneumonectomy empyema – report of 12-year experience

Wójcik

Grodzki²,

Kubisa³

et al. 2012

neo

View full text Add to dashboard Cite

show abstract

“…Postpneumonectomy thoracic empyema is a result of bronchopleural fistula in 80-100% of the cases [56,69,70], with a mortality ranging between 5% and 25% on average [66] with up to 40% if pleuropneumonectomy is performed [71] with a maximum value of 75% [35].…”

Section: Open Window Thoracostomy (Owt)/fenestration/ Empyema Marsupimentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

205

182

View full text Add to dashboard Cite

A review of the recent literature on treatment modalities of adult thoracic empyema was conducted in order to expose the controversies and verify where consensus exists. Critical reading filtered through clinical experience was the method followed. The roles of surgical drainage, lavage techniques, debridement via VATS, decortication, thoracoplasty and open window thoracostomy were considered using the Oxford Center of Evidence Based Medicine criteria. The roles of the different therapeutical modalities were interpreted in the light of the triphasic nature of empyema thoracis. The randomised controlled trials came up with conflicting results. With two exceptions all of the papers reviewed provide level (2b) or below evidences. The lack of a single ideal treatment modality or policy reflects the complexity of the diagnosis and staging of this heterogeneous disease. Basic elements of intervention--drainage, different evacuation techniques, decortication, thoracoplasty and open window thoracostomy--are well-established technical modalities; however, neither a universally acceptable primary modality nor the gold standard of their sequence is available. Drainage remains to be the initial treatment modality in Phase I disease. Debridement via VATS is a safe, reliable and efficient method in the fibrinopurulent phase. Organised pleural callus requires formal decortication. Open window thoracostomy is a simple and safe procedure for high-risk patients and results in quick detoxication. Thoracoplasty kept its final role in pleural space management. Acute postoperative bronchial stump insufficiency requires immediate surgery. Evacuation of toxic material is mandatory. No single-stage procedure offers a solution. An optimised agressivity treatment modality should be tailored to the condition of the patient and to the potential of the persisting cavity. Decision-making involves a triad consisting of the aetiology of empyema (i.e. primary vs secondary), general condition of the patient and stage of disease, while considering the triphasic nature of development of thoracic empyema. The current attitudes show that the present concepts are based mainly on expert opinion. Flexibility and patience on behalf of the surgeon and nursing staff, the patient and the hospital management, as well as a good understanding of the complexity of this condition are the cornerstones of the treatment. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualised approaches can be recommended based on institutional practice and local protocols. Thoracic empyema in general seems to remain resilient to fit completely into the categories of evidence-based medical approach.

show abstract

“…Among the major fatal complications causing decreased survival rate, bronchopleural fistula (BPF) still troubles thoracic surgeons because of the devastating leakage from airways into pleural space (9,10). Although the incidence of BPF has been largely decreased during the last few decades, the mortality caused by its adverse effects remains high (18-50%) (9).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients

Fan

Liu

et al. 2016

Jpn. J. Clin. Oncol.

View full text Add to dashboard Cite

Objective: Neoadjuvant therapy has been extensively analyzed in studies addressing the risk factors of bronchopleural fistula, but their results vary hugely. Therefore, we conducted this meta-analysis to determine the association between neoadjuvant therapy and risk of bronchopleural fistula in patients undergoing lung cancer surgery. Methods: We searched PubMed and EMBASE to identify the full-text literatures that met our eligibility criteria. Odds ratio with 95% confidence interval served as the summarized statistics. Heterogeneity within this meta-analysis was evaluated by Q-test and I 2 statistic. Sensitivity analysis was performed for further assessments of robustness. Publication bias was detected by Begg's test and Egger's test.Results: Thirty studies enrolling 14 912 lung cancer cases were included into this meta-analysis. The incidence of bronchopleural fistula was 2.4% (354/14 912) in the large scale. Overall, neoadjuvant therapy significantly increased the risk of bronchopleural fistula after pulmonary resections (odds ratio: 2.166; 95% confidence interval: 1.398-3.357; P = 0.001). In subgroup analysis, neoadjuvant radiotherapy (odds ratio: 3.914; 95% confidence interval: 1.401-10.935; P = 0.009) and chemo-radiation (odds ratio: 2.533; 95% confidence interval: 1.353-4.741; P = 0.004) were significantly associated with the bronchopleural fistula risk but neoadjuvant chemotherapy was not (odds ratio: 1.857; 95% confidence interval: 0.881-3.911; P = 0.104). The impact of neoadjuvant therapy on bronchopleural fistula occurrence remains statistically prominent in the other subgroups. Conclusions: Neoadjuvant therapy is significantly associated with the occurrence of bronchopleural fistula after lung cancer surgery. Both neoadjuvant radiotherapy and chemo-radiation significantly increase the bronchopleural fistula risk but neoadjuvant chemotherapy does not. Some limitations still exist in this meta-analysis. The updated high-quality studies can help to further confirm and enrich our discoveries in the future.

show abstract

Postpneumonectomy Empyema: Results After the Clagett Procedure

Cited by 117 publications

References 11 publications

Accelerated treatment of postpneumonectomy empyema – report of 12-year experience

Accelerated treatment of postpneumonectomy empyema – report of 12-year experience

Current surgical treatment of thoracic empyema in adults

Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients

Contact Info

Product

Resources

About