title: Morbidity and mortality after 94 extrapleural pneumonectomies for empyema.
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.
authors.affiliation: Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan. yujishi@mvb.biglobe.ne.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Shiraishi
authors.forename: Y
authors.initials: Y
authors.lastname: Nakajima
authors.forename: A
authors.initials: A
authors.lastname: Koyama
authors.forename: K
authors.initials: K
authors.lastname: Takasuna
authors.forename: N
authors.initials: N
authors.lastname: Katsuragi
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
mesh_terms: 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