P-220THORACOTOMY VERSUS VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR PLEURAL DECORTICATION IN STAGE III PLEURAL EMPYEMA: AN ANALYSIS OF 217 CONSECUTIVE PATIENTS

Objectives: Pleural empyema (PE) is an infectious disease of the chest cavity, with a high morbidity and mortality. PE gets graduated into three stages (American Thoracic Society / ATS, 1962), with surgery being indicated in stages II (evacuation of fluid-chambers) and III (removal of fibrotic membranes from the visceral pleura/decortication and from the chest wall, mediastinum and diaphragm). Evidence for the feasibility and outcomes of a minimally-invasive video-assisted thoracoscopic (VATS) approach in stage III (chronic) empyema is still little. Methods: Retrospective single-centre analysis of patients conducted to surgery for PE stage III (regarding ATS) from May 2002 to April 2014 either VATS (n = 110) or conventional open surgery (COS) (n = 107). Multiple regression analysis was used to evaluate the influence of the operation technique (COS or VATS) on the length of postoperative hospitalization. Results: Operation time was slightly longer in the COS group (P = 0.06). The five conversions in the VATS group were due to technical reasons (three) and pulmonary arterial bleeding (two). Postoperative complication (63 patients in COS and 57 in VATS group), recurrence (3 patients in COS and 5 in VATS group) and mortality rate (6.5% in COS and 9.1% in VATS group) did not differ between both groups, the length of postoperative stay at the intensive care unit was longer in the VATS group. Duration of chest tube drainage and rate of prolonged air leak (assessed by chest tube duration ≥7 days and ≥10 days) were similar in both groups, leading to a similar overall length of stay in both groups. Adjusted to clinically and statistically relevant confounders the multiple regression analysis showed an influence of the surgical technique on the duration of postoperative hospitalization (B = -0.134 for COS = 0 and VATS = 1). Conclusion: VATS in late-stage PE is feasible and safe. Short-term results are similar or even slightly better for the minimally-invasive decortication compared to COS. Disclosure: No significant relationships.