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Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：术后脓胸严重，潜在的致命并发症也存在，但对胸膜间皮瘤手术患者的研究很少。我们旨在分析哪些围手术期特征可能与术后脓胸的风险增加有关。
方法：从1999年9月至2023年2月，对在苏黎世大学医院接受胸膜间皮瘤手术的连续患者进行了回顾性分析。采用单因素和多因素logistic回归分析术后脓胸的相关危险因素。
结果：400名PM患者被纳入分析，其中n=50例患者在手术后出现脓胸（12.5%）。有脓胸（Eyes）和无脓胸（Eno）的患者的基线人口统计学具有可比性。39%(n=156)的患者接受了胸膜外肺切除术,其中22％（n=35）发生术后胸膜脓胸；其余244例患者（n=46）中的6％（n=15），扩大胸膜切除术和剥脱术（n=114），胸膜部分切除术（n=54）或开胸探查术（n=30）导致术后脓胸。在多变量逻辑回归分析中，当控制吸烟状态时，胸膜外肺切除术（比值比2.8，95％置信区间1.5-5.4，p=0.002）是与术后脓胸相关的唯一危险因素。Eyes的中位总生存期明显更差(16个月，四分位数范围5-27个月)比Eno(18个月，四分位数范围8-35个月)。
结论：与接受其他类型手术的患者相比，接受胸膜外肺切除术的患者发生术后胸膜脓胸的风险明显更高。脓胸患者的生存期明显缩短。人们担心辅助放疗与术后脓胸之间可能存在联系。
方法：从1999年9月至2023年2月，对在苏黎世大学医院接受胸膜间皮瘤手术的连续患者进行了回顾性分析。采用单因素和多因素logistic回归分析术后脓胸的相关危险因素。
结果：400名PM患者被纳入分析，其中n=50例患者在手术后出现脓胸（12.5%）。有脓胸（Eyes）和无脓胸（Eno）的患者的基线人口统计学具有可比性。39%(n=156)的患者接受了胸膜外肺切除术,其中22％（n=35）发生术后胸膜脓胸；其余244例患者（n=46）中的6％（n=15），扩大胸膜切除术和剥脱术（n=114），胸膜部分切除术（n=54）或开胸探查术（n=30）导致术后脓胸。在多变量逻辑回归分析中，当控制吸烟状态时，胸膜外肺切除术（比值比2.8，95％置信区间1.5-5.4，p=0.002）是与术后脓胸相关的唯一危险因素。Eyes的中位总生存期明显更差(16个月，四分位数范围5-27个月)比Eno(18个月，四分位数范围8-35个月)。
结论：与接受其他类型手术的患者相比，接受胸膜外肺切除术的患者发生术后胸膜脓胸的风险明显更高。脓胸患者的生存期明显缩短。人们担心辅助放疗与术后脓胸之间可能存在联系。
