Accelerated treatment of postpneumonectomy empyema: A binational long-term study

Objective: Postpneumonectomy empyema remains a clinical challenge. We proposed an accelerated therapy without an open chest window 5 years ago. This concept was evaluated on a larger scale in 2 centers in 2 different countries. Methods: Between July 1995 and October 2005, 75 consecutive patients with postpneumonectomy empyema were treated in Szczecin, Poland ( n = 35), and Zurich, Switzerland ( n 5 40). The therapy consisted of repeated open surgical debridement of the pleural cavity after achievement of general anesthesia, a negative pressure wound therapy of the temporarily closed chest cavity filled with povidone-iodine soaked towels, and continuous suction and systemic antimicrobial therapy. If present, bronchopleural fistulae were closed and reinforced either with a muscle flap or the omentum. Finally, the pleural space was filled with an antibiotic solution and definitively closed. Results: Of 75 patients ( 63 men; median age, 59 years; age range, 19 - 82 years), postpneumonectomy empyema was present on the right in 46 patients ( 32 with bronchopleural fistula) and in 29 patients ( 12 with bronchopleural fistula) on the left. Median time between pneumonectomy and postpneumonectomy empyema was 131 days ( range, 7 - 7200 days). Bronchopleural fistulae have been closed and additionally reinforced by means of different methods ( omentum, 18; muscle, 11; pericardial fat, 5; azygos vein, 1). The chest was definitively closed within 8 days in 94.6% of patients. The median hospitalization time was 18 days ( range, 9 - 134 days). Postpneumonectomy empyema was successfully treated in 97.3% of patients, including 10 ( 13%) patients who needed a second treatment cycle. Three ( 4%) patients died within 90 days. The median follow-up time was 29.5 moths ( range, 3 - 107 months). Conclusions: Treatment of postpneumonectomy empyema with the accelerated treatment is effective and safe. Our results are superior compared with those in reported series using a ( temporary) chest fenestration. Patients appreciate the physical integrity of the chest.