Morbidity and mortality after 94 extrapleural pneumonectomies for empyema.
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.
Shiraishi
Y
Y
Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan. yujishi@mvb.biglobe.ne.jp
Nakajima
Y
Y
Koyama
A
A
Takasuna
K
K
Katsuragi
N
N
Yoshida
S
S
D000328:Adult; D000368:Aged; D002423:Cause of Death; D016724:Empyema, Pleural / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000401:mortality / Q000601:surgery