Outcome of Pleural Empyema Treated With Video-Assisted Thoracoscopic Surgery in Patients With Severe Co-Morbidities: An Observational Study.

Background: Empyema patients with poor physical condition and severe comorbidities face a significant challenge, with difficulties in choosing appropriate treatment methods, limited treatment outcomes, and a high rate of complications and mortality.

Objective: To comment on the indications and to evaluate the treatment outcomes of pleural empyema in patients with poor physical condition and severe comorbidities by thoracoscopic surgery.

Methods: An observational study on 12 patients treated at the Department of Thoracic Surgery - Military Hospital 103, from January 2017 to December 2022.

Results: The mean of age was 63.4 ± 12.4 years old, with a male/female ratio of 5/1. In this study, 83.3% of cases were presented with stage II empyema. The mean Karnofsky score was 50.0 ± 6.1. Some comorbidities contained chronic obstructive pulmonary disease (COPD) (25.0%), spontaneous esophageal perforation (16.7%), liver cancer, cirrhosis, esophageal cancer, end-stage renal failure - chronic dialysis (8.7%). The surgery procedures were efficient with a short duration (65.6 ± 9.4 minutes), low incidence of blood transfusion (8.3%), and lower rate of postoperative complications (surgical wound infection 8.3%). The length of postoperative stay was 16.8 ± 9.9 days. Pleural drainage was removed in 11 out of 12 cases after an average of 60.1 ± 8.5 days, while one patient had their drainage retained due to esophageal cancer. The total recovery rate at the 1-year follow-up was 91.7%.

Conclusion: Video-Assisted Thoracoscopic Surgery (VATS) exhibits positive outcomes in treating stage I and II pleural empyema patients who incurred severe comorbidities.