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Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema—an analysis of 217 consecutive patients

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Abstract

Background

Pleural empyema is an infectious disease of the chest cavity, with a high morbidity and mortality. According to the American Thoracic Society, pleural empyema gets graduated into three stages, with surgery being indicated in intermediate stage II and chronic stage III. Evidence for the feasibility of a minimally-invasive video-assisted thoracoscopic approach in stage III empyema for pulmonary decortication is still little.

Methods

Retrospective single-center analysis of patients conducted to surgery for chronic stage III pleural empyema from 05/2002 to 04/2014 either by video-assisted thoracoscopic surgery (VATS, n = 110) or conventional open surgery by thoracotomy (n = 107). Multiple regression analysis and propensity score matching was used to evaluate the influence of operation technique (thoracotomy versus VATS) on the length of post-operative hospitalization.

Results

Operation time was longer in the thoracotomy-group (p = 0.0207). Conversion rate from VATS to open surgery by thoracotomy was 4.5%. Post-operative complication- (61 patients in thoracotomy- and 55 patients in VATS-group), recurrence- (3 patients in thoracotomy- and 5 in VATS-group) and mortality-rates (6.5% in thoracotomy- and 9.5% in VATS-group) did not differ between both groups; the length of (post-operative) stay at intensive care unit was longer in the VATS-group (p = 0.0023). Duration of chest tube drainage and prolonged air leak rate were similar among both groups, leading to a similar overall and post-operative length of hospital stay in both groups. Adjusted to clinically and statistically relevant confounders, multiple regression analysis showed an influence of the surgical technique on length of post-operative stay after pair matching of the patients (n = 84 in each group) by propensity score (B = − 0.179 for thoracotomy = 0 and VATS = 1, p = 0.032) leading to a reduction of 0.836 days after a VATS-approach compared to thoracotomy.

Conclusions

VATS in late stage (III) pleural empyema is feasible and safe. The decrease in post-operative hospitalization demonstrated by adjusted multiple regression analysis may indicate the minimally-invasive approach being safe, more tolerable for patients, and more effective.

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Authors and Affiliations

  1. Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany

    Martin Reichert, Bernd Pösentrup, Andreas Hecker, Winfried Padberg & Johannes Bodner

  2. Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany

    Emmanuel Schneck

  3. Medical Statistics, Institute of Medical Informatics, Justus-Liebig-University of Giessen, Rudolf-Buchheim Strasse 6, 35392, Giessen, Germany

    Jörn Pons-Kühnemann

  4. Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria

    Florian Augustin, Dietmar Öfner & Johannes Bodner

  5. Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany

    Johannes Bodner

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  1. Martin Reichert
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  2. Bernd Pösentrup
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  3. Andreas Hecker
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  4. Emmanuel Schneck
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  6. Florian Augustin
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  9. Johannes Bodner
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Correspondence to Martin Reichert.

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Disclosures

Martin Reichert, Bernd Pösentrup, Andreas Hecker, Emmanuel Schneck, Jörn Pons-Kühnemann, Florian Augustin, Winfried Padberg, Dietmar Öfner, and Johannes Bodner have no conflicts of interest or financial ties to disclose.

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Reichert, M., Pösentrup, B., Hecker, A. et al. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema—an analysis of 217 consecutive patients. Surg Endosc 32, 2664–2675 (2018). https://doi.org/10.1007/s00464-017-5961-7

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  • DOI: https://doi.org/10.1007/s00464-017-5961-7

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