title: Debridement alone without decortication can achieve lung re-expansion in patients with empyema: an observational study.
abstract: Decortication is widely performed for empyema, but the effectiveness in achieving lung re-expansion has never been formally reported. The aim of this study is to quantify the degree of lung re-expansion in comparison to that achieved naturally after debridement alone. A retrospective review of patients who underwent either decortication or debridement for empyema between 2007 and 2009. The change of the cavity size with time were standardized and recorded before, immediately after surgery and on follow-up. Of 25 patients who underwent surgical management of empyema, 16 (64%) underwent debridement alone and nine (36%) underwent decortication. The mean age (standard deviation) was 58 (19) years and 15 (60%) were male. On radiological follow-up at a median [interquartile range (IQR)] of 45 (36-116) days, further reduction of 36% and 34% was achieved leaving 27% and 12% of the original cavity size in the debridement and decortication groups, respectively. Procedure (debridement or decortication) was not associated with any difference to the eventual follow-up cavity size (P = 0.937). Similar follow-up results were achieved by debridement alone without decortication in patients presenting with empyema, despite the presence of an underlying trapped lung.
authors.affiliation: Academic Division of Thoracic Surgery, The Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Kho
authors.forename: Jayenthan
authors.initials: J
authors.lastname: Karunanantham
authors.forename: Maria
authors.initials: M
authors.lastname: Leung
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement / Q000009:adverse effects / Q000401:mortality; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008131:London; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome