ArticleMedicine2026
The efficacy and safety of medical thoracoscopy compared with tube thoracostomy in the treatment of complicated parapneumonic effusion and empyema: A retrospective single-center study.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
To evaluate the efficacy and safety of medical thoracoscopy (MT) compared with tube thoracostomy (TT) for complicated parapneumonic effusion (CPPE) and empyema. We retrospectively analyzed 79 adults with stage 5 CPPE or empyema treated from May 2018 to January 2024. Patients were non-blindly assigned to an MT group (n = 25) or TT group (n = 54) according to attending physician discretion, imaging findings, clinical status, procedural suitability, and physician expertise. Baseline characteristics, pleural fluid biochemistry, clinical improvement, treatment failure, in-hospital mortality, total pre-intervention and post-intervention hospitalization, pleural fluid drainage volume, and postoperative complications were compared. Clinical improvement required symptom resolution plus radiographic reduction without further invasive intervention; treatment failure included persistent sepsis, additional intervention, or pleural-infection-related death. Median total hospitalization was 17 days (inerquartile range [IQR], 13-22) in the TT group and 20 days (IQR, 16-25) in the MT group, without a significant difference (P > .05). The MT group had more loculation/septation (92.0% vs 68.5%, P = .023) and longer pre-intervention hospitalization (7 days, IQR 5-11 vs 2 days, IQR 1-3; P < .05), suggesting more complex disease and delayed escalation. Post-intervention hospitalization was shorter after MT (10 days, IQR 6-17) than TT (15 days, IQR 11-20) (P < .05). Pleural fluid drainage volume was greater after MT (1210 mL, IQR 475-2300) than TT (600 mL, IQR 245-1212) (P < .05). Clinical improvement, treatment failure, adverse reactions, and mortality did not differ significantly between groups (P > .05). The overall adverse reaction rate was 16.0% after MT and 3.6% after TT (P = .076). MT appears feasible and safe for selected patients with CPPE and empyema. It was associated with greater pleural drainage and shorter post-intervention hospitalization than TT, despite use in patients with more complex disease. However, because this retrospective study involved non-blinded treatment allocation, selection bias, baseline imbalance, and a small sample, the findings are hypothesis-generating rather than definitive. MT did not show a statistically significant effect on in-hospital mortality. Prospective randomized studies are needed to define its optimal timing and role in pleural infection management.
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