Risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma: a retrospective single-centre analysis

Eur J Cardiothorac Surg. 2024 Mar 29;65(4):ezae137. doi: 10.1093/ejcts/ezae137.


Objectives: Postoperative empyema is a severe, potentially lethal complication also present, but poorly studied in patients undergoing surgery for pleural mesothelioma. We aimed to analyse which perioperative characteristics might be associated with an increased risk for postoperative empyema.

Methods: From September 1999 to February 2023 a retrospective analysis of consecutive patients undergoing surgery for pleural mesothelioma at the University Hospital of Zurich was performed. Uni- and multivariable logistic regression was used to identify associated risk factors of postoperative empyema after surgery.

Results: A total of 400 PM patients were included in the analysis, of which n = 50 patients developed empyema after surgery (12.5%). Baseline demographics were comparable between patients with (Eyes) and without empyema (Eno). 39% (n = 156) patients underwent extrapleural pneumonectomy (EPP), of whom 22% (n = 35) developed postoperative pleural empyema; 6% (n = 15) of the remaining 244 patients undergoing pleurectomy and decortication (n = 46), extended pleurectomy and decortication (n = 114), partial pleurectomy (n = 54) or explorative thoracotomy (n = 30) resulted in postoperative empyema. In multivariable logistic regression analysis, EPP (odds ratio 2.8, 95% confidence interval 1.5-5.4, P = 0.002) emerged as the only risk factor associated with postoperative empyema when controlled for smoking status. Median overall survival was significantly worse for Eyes (16 months, interquartile range 5-27 months) than for Eno (18 months, interquartile range 8-35 months).

Conclusions: Patients undergoing EPP had a significantly higher risk of developing postoperative pleural empyema compared to patients undergoing other surgery types. Survival of patients with empyema was significantly shorter.

Keywords: Extrapleural pleuropneumonectomy; Macroscopic complete resection; Multimodal therapy; Pleural mesothelioma; Postoperative pleural empyema.

MeSH terms

  • Aged
  • Empyema, Pleural* / epidemiology
  • Empyema, Pleural* / etiology
  • Empyema, Pleural* / surgery
  • Female
  • Humans
  • Lung Neoplasms / surgery
  • Male
  • Mesothelioma / mortality
  • Mesothelioma / surgery
  • Mesothelioma, Malignant / surgery
  • Middle Aged
  • Pleural Neoplasms* / mortality
  • Pleural Neoplasms* / surgery
  • Pneumonectomy / adverse effects
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Retrospective Studies
  • Risk Factors