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

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.