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A. Elbastaweesy
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P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.08-003 - Incidence and Management of Malignant Pleural Mesothelioma Related Empyema (ID 990)
09:30 - 09:30 | Author(s): A. Elbastaweesy
- Abstract
Background:
Empyema in relation to malignant pleural mesothelioma is a serious complication that may stop or delay the planned treatment. It may be secondary to surgery or non surgical , both are difficult to treat and are challenging to the thoracic surgeon as patients are usually too ill to tolerate therapy.
Methods:
We retrospectively reviewed the data of 443 patients with mesothelioma referred to the National Cancer Institute, Cairo between 2004 -2013. Extra pleural pnuemonectomy (EPP) was performed in 93 patients and radical pleurectomy / decortication in 12 . The remaining 338 patients received palliative chemotherapy or best supportive care. The frequency of empyema among those patients was 5.86% (26 cases). Full history and clinical examination was done for all patients, culture from the chest tube and or sputum culture was ordered for all, Computed tomography of the chest was done to evaluate empyema in all patients and bronchoscopy and biopsy to exclude stump recurrence was requested for patients with empyema secondary to EPP.
Results:
There were 23 males and 3 females , the right side was affected in 17 patients. Of the 338 patients with non operative therapy, 17(5%) developed empyema , 5 following repeated tapping of effusion ,8 with prolonged chest tube insertion and 4 after pleurodesis. Palliative pleurectomy was possible in 4 patients and was successful in 2. The remaining 13 patients were treated with second chest tube and repeated cavity irrigation with diluted bovidon iodine, 5 of them were improved within 2-3 weeks. Empyema secondary to EPP developed in 8 patients, 2 had early post operative empyema, one with stump dehiscence and one secondary to tube thoracostomy in the post pneumonectomy space. Surgery was successful in both. Of the remaining 6 patients, 5 had delayed bronchial stump fistula 1-3 years post pleuro pneumonectomy, All were re explored. Two patients were cured, the remaining 4 died from persistent sepsis. The last patient had infected mesh 3 years after surgery and was treated by re surgery and mesh removal. We had one patient with empyema following radical pleurectomy/ decortication due to residual space, wound depridement was done and the procedure was successful.
Conclusion:
Treatment of mesothelioma patients with empyema is challenging, every patient should be and evaluated and treated separately. In spite of high failure rate with surgery, it's considered the only treatment option, great effort by high volume thoracic surgeon should be offered to this group of patients.
