Lung Resection for Lung Cancer after Pleural Empyema

Abstract

Background The association of pleural empyema and lung cancer has traditionally been considered as a contraindication for lung resection. However, several aspects of this problem still remain controversial.

Materials and Methods A retrospective study was conducted including 15 patients (12 pneumonectomies and 3 lobectomies) who underwent a lung resection for primary lung cancer after previous pleural empyema.

Results In all but one patient, empyema was treated by chest tube for 15 to 40 days. In only two patients, the diagnosis of empyema preceded the diagnosis of lung cancer. Among patients with pneumonectomy, a good intrapleural cleavage plane existed in only one patient with no signs of infection. In each patient with a lobectomy, preoperative chest tube aspiration took 20 to 30 days and in none of them intraoperative signs of infection existed. In patients with pneumonectomy, empyema without bronchopleural fistula occurred in two patients, while in one patient, empyema was associated with fistula. The operative morbidity after pneumonectomy was 33.3%.

Conclusion Association of pleural empyema and lung cancer is not an absolute contraindication for surgery. Potentially curative operation is possible, provided a full control of infection is achieved.

Keywords

lung cancer - lobectomy - pneumonectomy - pleural empyema

• References

• 1 Sok M, Dragas AZ, Erzen J, Jerman J. Sources of pathogens causing pleuropulmonary infections after lung cancer resection. Eur J Cardiothorac Surg 2002; 22 (1) 23-27 , discussion 27–29
• 2 De Leyn P, Lardinois D, Van Schil PE , et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg 2007; 32 (1) 1-8
• 3 Vianna NJ. Nontuberculous bacterial empyema in patients with and without underlying diseases. JAMA 1971; 215 (1) 69-75
• 4 Riquet M, Hubsch JP, Le Pimpec Barthes F , et al. Pleurésies purulentes et cancer du poumon. Formes non iatrogènes et prise en charge thérapeutique. Rev Mal Respir 1999; 16 (5) 817-822
• 5 Ernst M, Nies C. Pneumonectomy for lung cancer after pleural empyema. Chirurg 1999; 70 (12) 1480-1483
• 6 Chaudhuri MR. Primary pulmonary cavitating carcinomas. Thorax 1973; 28 (3) 354-366
• 7 Pan JF, Yang PC, Chang DB, Lee YC, Kuo SH, Luh KT. Needle aspiration biopsy of malignant lung masses with necrotic centers. Improved sensitivity with ultrasonic guidance. Chest 1993; 103 (5) 1452-1456
• 8 Kacprzak G, Marciniak M, Addae-Boateng E, Kolodziej J, Pawelczyk K. Causes and management of postpneumonectomy empyemas: our experience. Eur J Cardiothorac Surg 2004; 26 (3) 498-502
• 9 Molina R, Baró T, Torné J , et al. Empyema caused by Kingella denitrificans and Peptostreptococcus spp. in a patient with bronchogenic carcinoma. Eur Respir J 1988; 1 (9) 870-871
• 10 Froeschle P, Wanke W, Granetzny A. Video-thoracoscopy and staged management of preoperative empyema in lung cancer. Thorac Cardiovasc Surg 2005; 53 (3) 188-190
• 11 Strauss GM, Herndon J, Maddaus MA , et al. Randomized clinical trial of adjuvant chemotherapy with paclitaxel and carboplatin following resection in stage 1B non-small-cell lung cancer (NSCLC): Report of Cancer and Leukemia Group B (CALGB) Protocol 9633. J Clin Oncol 2004; 22 (14) 7019
• 12 Winton T, Livingston R, Johnson D , et al; National Cancer Institute of Canada Clinical Trials Group; National Cancer Institute of the United States Intergroup JBR.10 Trial Investigators. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 2005; 352 (25) 2589-2597
• 13 Scagliotti GV, Fossati R, Torri V , et al; Adjuvant Lung Project Italy/European Organisation for Research Treatment of Cancer-Lung Cancer Cooperative Group Investigators. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 2003; 95 (19) 1453-1461
• 14 Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Recent results of postoperative mortality for surgical resections in lung cancer. Ann Thorac Surg 2004; 78 (3) 999-1002
• 15 Ramnath N, Demmy TL, Antun A , et al. Pneumonectomy for bronchogenic carcinoma: analysis of factors predicting survival. Ann Thorac Surg 2007; 83 (5) 1831-1836
• 16 Ludwig C, Stoelben E, Olschewski M, Hasse J. Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma. Ann Thorac Surg 2005; 79 (3) 968-973
• 17 Goldstraw P. Postpneumonectomy empyema. The cloud with a silver lining?. J Thorac Cardiovasc Surg 1980; 79 (6) 851-855
• 18 Harada M, Yoshida J, Yokose T . et al. Surgical management of primary lung cancer in an elderly patient with preoperative empyemaJpn. J Clin Oncol 1999; 29 (11) 571-575