Uniportal Thoracoscopy with Enhanced Recovery Program is the Optimal Approach in Management of Pleural Empyema

Title: Uniportal Thoracoscopy with Enhanced Recovery Program is the Optimal Approach in Management of Pleural Empyema
Author(s): M Aladaileh 1, M Ni Fhlatharta , J Olaniyil 1, R Brown 1, KC Redmond 1
Institution: The Mater Misericordiae University Hospital
Poster: Click to view poster
Category: Lung Cancer/CF/ILD/Surgery
Abstract: Background
In recent years, there has been a paradigm shift in the management of pleural empyema towards minimally invasive modalities. Till today, few reports represent uniportal-video assisted thoracic surgery (U-VATS) for treating empyema patients. The present work aimed to retrospectively assess the U-VATS decortication before and after implementing the enhanced recovery after surgery (ERAS) protocol and compairing the results with the traditional approaches in the literature.
A single-centre retrospective analysis of 120 consecutive patients who underwent U-VATS decortication from Janaury 2015 to June 2019. The patients were divided into ERAS and non-ERAS group. The main outcome measures were the postoperative length of stay (LOS) and post-operative drainage duration. These measures were analyzed statistically between the two groups. ERAS principles were documented. Literature review of uniportal decortication.
The mean age of patients was 56 years and 67% of them were males. Complete decortication was obtained in all patients through U-VATS approach. Fifty patients (41.6%) presented with stage II and 70 patients (58.3%) stage III empyema. The non-Eras and Eras group are comparable in demographics, patient characteristics and the stage of empyema. The mean length of hospital stay for all the patients was 5.4±3.9 days, and the post-operative chest tube duration was 5.1±3.6. Length of stay were shorter in the ERAS group compared with the non-ERAS group with significant P-value (0.005). Nine patients (7.5%) showed complications, including bleeding (2 patients), short term recurrence (2 patients), persistent pleural space (4 patients) and prolonged air leak (1 patients). No mortalities were reported. No statistical differences were observed in the postoperative complications of the two groups.
In addition, the literature review shows that the uniportal VATS is superior to the multiportal VATS and the open approach.
U-VATS decortication is an adequate approach in the treatment of stages II and III empyema, and when it is aligned to an ERAS protocols demonstrates superior outcomes in terms of length of stay and post-operative chest drain duration compared to the non-ERAS group and the other surgical approaches.