From the Guidelines
Decortication plays a crucial role in treating empyema, particularly in patients with a trapped lung, as it facilitates optimal clearance of infected material and achieves lung re-expansion.
Key Considerations
- The decision to perform decortication should be individualized to the patient based on assessment of patient fitness and empyema stage 1.
- Surgical access should be selected to facilitate optimal clearance of infected material and achieve lung re-expansion where appropriate 1.
- The extent of surgery should be tailored according to patient and empyema stage, with options including drainage vs debridement 1.
Evidence and Outcomes
- Decortication surgery for pleural infection may be associated with a longer postoperative stay and higher mortality than surgery that does not involve decortication, but is associated with less breathlessness 1.
- There is insufficient evidence to accurately address the question of decortication in empyema treatment, with published evidence limited to highly selected, non-randomised patients 1.
- Pleurodesis failure rates may increase in patients with malignant pleural effusion (MPE) with non-expandable lung if thoracoscopic decortication is not performed 1.
From the Research
Role of Decortication in Treating Empyema
The role of decortication in treating empyema is a significant one, with various studies highlighting its effectiveness in managing the condition.
- Decortication is recommended by national guidelines for the management of early empyema 2.
- A study comparing the cost-effectiveness of video-assisted thoracoscopic surgery (VATS) decortication with intrapleural fibrinolysis for early empyema found that intrapleural tissue plasminogen activator and deoxyribonuclease were more cost-effective than VATS decortication 2.
- Another study evaluating the comparative merits of thoracoscopic versus open decortication in the surgical management of patients with chronic postpneumonic pleural empyema found that the videothoracoscopic approach showed statistically significant better results in terms of in-hospital postoperative pain, postoperative air leak, operative time, hospital stay, and time to return to work 3.
Effectiveness of Decortication
The effectiveness of decortication in treating empyema is well-documented in various studies.
- A study analyzing the medical records of 111 patients who presented with empyema and were treated with simple drainage or surgical decortication as the first line of treatment found that surgical decortication showed a better treatment success rate in all study subjects (96.3%) compared with simple drainage (58.3%) 4.
- A prospective study on a consecutive series of patients with chronic parapneumonic empyema found that decortication was a highly effective treatment, with all 40 patients having definitive resolution of the empyema and 87.5% having an uneventful postoperative course 5.
- A study on decortication for chronic postpneumonic empyema found that decortication remains a highly effective treatment, with only one recurrence and one mortality (4 percent) among 25 adult patients 6.
Comparison with Other Treatments
Decortication has been compared with other treatments for empyema, including intrapleural fibrinolysis and simple drainage.
- A study comparing the cost-effectiveness of VATS decortication with intrapleural fibrinolysis found that intrapleural tissue plasminogen activator and deoxyribonuclease were more cost-effective than VATS decortication 2.
- A study comparing surgical decortication with simple drainage found that surgical decortication showed a better treatment success rate in all study subjects (96.3%) compared with simple drainage (58.3%) 4.