ArticleJournal of clinical medicine2022
Which Surgery for Stage II-III Empyema Patients? Observational Single-Center Cohort Study of 719 Consecutive Patients.
Article in Journal of clinical medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 14 citations in OpenAlex.
- Video-Assisted Thoracoscopic Surgery Versus Thoracotomy for Pleural Empyema: Outcomes and Risk Factors in a Retrospective Single-Center Cohort Study.Journal of cardiothoracic surgery · 2026Article
- Successful two-port video-assisted thoracoscopic surgery for acute empyema in a high-risk patient with a high RAPID score: a case report.AME case reports · 2026Article
- Thoracoplasty Without Rib Resection by the Sawamura Technique: A Forgotten Technique for Effective Complex Pleural Empyema Management in a Single-Step.Journal of clinical medicine · 2025Article
- Predictors of successful closure following open-window thoracostomy in patients with empyema: a single-center retrospective cohort study.Journal of thoracic disease · 2025Article
- Risk factors and prognostic predictors of recurrent bacterial empyema in patients after surgical treatment.BMC infectious diseases · 2025Article
- Pleural infection: controversies on the therapeutic strategies.Current opinion in pulmonary medicine · 2025Review
- Pleural Infection: Diagnosis, Management, and Future Directions.Journal of clinical medicine · 2025Review
- Infective Pleural Effusions-A Comprehensive Narrative Review Article.Clinics and practice · 2024Review
- Beyond diagnosis: a narrative review of the evolving therapeutic role of medical thoracoscopy in the management of pleural diseases.Journal of thoracic disease · 2024Review
- Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review.Journal of thoracic disease · 2023Review
- Comparison of video assisted thoracoscopic surgery and thoracotomy for treatment of pleural infection stage II and III: a literature review.Journal of thoracic disease · 2023Review
- Video-assisted medical thoracoscopy performed with a single-use bronchoscope: Case report of a critically ill patient with pleural empyema.Science progressArticle
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveRecent guidelines support the use of thoracoscopic surgery in stage II-III empyema; however, there is still debate regarding the best surgical approach. The aim of our study is to compare postoperative outcomes of VATS and open surgical approaches for the treatment of post-pneumonic empyema.
methodsObservational cohort study on prospectively collected cases of post-pneumonic empyema surgically treated in a single center (2000-2020). Patients were divided into an open group (OT, posterolateral muscle sparing thoracotomy) and VATS group (VT, 2 or 3 port ± utility incision). The primary outcome of the study was empyema resolution, assessed by the recurrence rate. Secondary outcomes were mortality, complications, pain and return to daily life. All patients were followed up at 1, 3 and 6 months after surgery in the outpatient clinic with a chest radiograph/CT scan.
resultsIn total, 719 consecutive patients were surgically treated for stage II-III empyema, with 644 belonging to the VT group and 75 to the OT group. All patients had a clinical history of pneumonia lasting no more than 6 months before surgery, and 553 (76.9%) had stage II empyema. Operative time was 92.7 ± 6.8 min for the OT group and 112.2 ± 7.4 for the VT group. The conversion rate was 8.4% (46/545) for stage II and 19.2% (19/99) for stage III. Twelve patients (1.86%) in the VT group and four patients (5.3%) in the OT group underwent additional surgery for bleeding. Postoperative mortality was 1.25% (9/719): 5.3% (4/75) in OT and 0.77% (5/644) in VT. Postoperative stay was 10 ± 6.5 days in OT and 8 ± 2.4 in VT. Overall morbidity was 14.7% (106/719): 21.3% (16/75) in OT and 13.9% (90/644) in VT. In VT, six patients (0.93%) showed recurrent empyema: five were treated with chest drainage and one with additional open surgery.
conclusionsOur findings suggest that the VATS approach, showing a 99% success rate, shorter length of stay and lower postoperative morbidity, should be considered the treatment of choice for thoracic empyema.
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