Interact CardioVasc Thorac Surg 2009;9:78. doi:10.1510/icvts.2009.203190A
© 2009 European Association of Cardio-Thoracic Surgery
eComment: Is video-assisted thoracoscopic surgery really superior to open decortication for empyema thoracis?
Frank Edwin and
Kwabena Frimpong-Boateng
National Cardiothoracic Centre, Korle Bu TeachingHospital, PO Box KB 846, Korle Bu, Accra, Ghana
Long-term functional results after surgical treatment of parapneumonic thoracic empyema
The report by Casali and colleagues [1] clearly demonstrates the effectiveness of thoracoscopic and open thoracotomy techniques when applied to the treatment of thoracic empyema. It is noteworthy that they found a striking concordance between the radiological and functional results. This underscores the importance of achieving optimal lung re-expansion as a target of surgical treatment. Our experience with 48 patients with ‘callous pleural-peel’ chronic empyema thoracis subjected to open thoracotomy and decortication between 1992 and 2008 is in support of this finding.
The authors ‘however’ suggest that video-assisted thoracoscopic surgery (VATS) is superior to open thoracotomy for debridement in functional outcome. Their finding is at variance with other reports [2–4] that indicate that open thoracotomy is at least equivalent or superior to VATS in terms of functional and radiological outcome. It is important to appreciate that thoracic empyema is a progressive triphasic disease [2] and results of treatment are influenced not only by the treatment modality applied but also (and probably more importantly) the stage of the disease at which treatment is applied. If outcomes for treatment modalities must be compared, patients in the two treatment arms must have similar demographics and disease stages. In the report of Chan and colleagues [3], both thoracotomy and VATS gave equally effective treatment for empyema in terms of radiologic and functional outcomes after a mean follow-up of 36 months (range 6–65 months); the durations between the time of diagnosis and the time of operation were similar in both the VATS and thoracotomy groups. Casali and colleagues' report [1] compared outcomes for two groups of patients subjected to VATS debridement (mean duration of infection 12±6 days) and those subjected to open thoracotomy debridement (mean duration of infection 32±22 days). Clearly, these two groups cannot be expected to have the same stage of impairment from empyema. To suggest, therefore, that VATS is superior to open thoracotomy debridement on these grounds is difficult to justify. Others [2–4] who have compared the two treatment modalities on patients with similar stages of empyema have not corroborated Casali and colleagues' findings on this issue.
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References
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- Casali C, Storelli ES, Di Prima E, Morandi U. Long-term functional results after surgical treatment of parapneumonic thoracic empyema. Interact CardioVasc Thorac Surg 2009;9:74–78.[Abstract/Free Full Text]
- Lardinois D, Gock M, Pezzetta E, Buchli C, Rousson V, Furrer M, Ris HB. Delayed referral and gram-negative organisms increase the conversion thoracotomy rate in patients undergoing video-assisted thoracoscopic surgery for empyema. Ann Thorac Surg 2005;79:1851–1856.[Abstract/Free Full Text]
- Chan DT, Sihoe AD, Chan S, Tsang DS, Fang B, Lee TW, Cheng LC. Surgical treatment for empyema thoracis: is video-assisted thoracic surgery ‘better’ than thoracotomy? Ann Thorac Surg 2007;84:225–231.[Abstract/Free Full Text]
- Angelillo Mackinlay TA, Lyons GA, Chimondeguy DJ, Piedras MA, Angaramo G, Emery J. VATS debridement versus thoracotomy in the treatment of loculated postpneumonia empyema. Ann Thorac Surg 1996;61:1626–1630.[Abstract/Free Full Text]
Related Article
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Long-term functional results after surgical treatment of parapneumonic thoracic empyema
- Christian Casali, Erica Susanna Storelli, Elena Di Prima, and Uliano Morandi
Interactive CardioVascular and Thoracic Surgery 2009 9: 74-78.
[Abstract]
[Full Text]
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