Surgical Endoscopy

, Volume 32, Issue 6, pp 2664–2675 | Cite as

Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema—an analysis of 217 consecutive patients

  • Martin Reichert
  • Bernd Pösentrup
  • Andreas Hecker
  • Emmanuel Schneck
  • Jörn Pons-Kühnemann
  • Florian Augustin
  • Winfried Padberg
  • Dietmar Öfner
  • Johannes Bodner



Pleural empyema is an infectious disease of the chest cavity, with a high morbidity and mortality. According to the American Thoracic Society, pleural empyema gets graduated into three stages, with surgery being indicated in intermediate stage II and chronic stage III. Evidence for the feasibility of a minimally-invasive video-assisted thoracoscopic approach in stage III empyema for pulmonary decortication is still little.


Retrospective single-center analysis of patients conducted to surgery for chronic stage III pleural empyema from 05/2002 to 04/2014 either by video-assisted thoracoscopic surgery (VATS, n = 110) or conventional open surgery by thoracotomy (n = 107). Multiple regression analysis and propensity score matching was used to evaluate the influence of operation technique (thoracotomy versus VATS) on the length of post-operative hospitalization.


Operation time was longer in the thoracotomy-group (p = 0.0207). Conversion rate from VATS to open surgery by thoracotomy was 4.5%. Post-operative complication- (61 patients in thoracotomy- and 55 patients in VATS-group), recurrence- (3 patients in thoracotomy- and 5 in VATS-group) and mortality-rates (6.5% in thoracotomy- and 9.5% in VATS-group) did not differ between both groups; the length of (post-operative) stay at intensive care unit was longer in the VATS-group (p = 0.0023). Duration of chest tube drainage and prolonged air leak rate were similar among both groups, leading to a similar overall and post-operative length of hospital stay in both groups. Adjusted to clinically and statistically relevant confounders, multiple regression analysis showed an influence of the surgical technique on length of post-operative stay after pair matching of the patients (n = 84 in each group) by propensity score (B = − 0.179 for thoracotomy = 0 and VATS = 1, p = 0.032) leading to a reduction of 0.836 days after a VATS-approach compared to thoracotomy.


VATS in late stage (III) pleural empyema is feasible and safe. The decrease in post-operative hospitalization demonstrated by adjusted multiple regression analysis may indicate the minimally-invasive approach being safe, more tolerable for patients, and more effective.


Video-assisted thoracoscopic surgery VATS Thoracotomy Pleural empyema Empyema thoracis Pleural infection 


Compliance with ethical standards


Martin Reichert, Bernd Pösentrup, Andreas Hecker, Emmanuel Schneck, Jörn Pons-Kühnemann, Florian Augustin, Winfried Padberg, Dietmar Öfner, and Johannes Bodner have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Martin Reichert
    • 1
  • Bernd Pösentrup
    • 1
  • Andreas Hecker
    • 1
  • Emmanuel Schneck
    • 2
  • Jörn Pons-Kühnemann
    • 3
  • Florian Augustin
    • 4
  • Winfried Padberg
    • 1
  • Dietmar Öfner
    • 4
  • Johannes Bodner
    • 1
    • 4
    • 5
  1. 1.Department of General, Visceral, Thoracic, Transplant and Pediatric SurgeryUniversity Hospital of GiessenGiessenGermany
  2. 2.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital of GiessenGiessenGermany
  3. 3.Medical Statistics, Institute of Medical InformaticsJustus-Liebig-University of GiessenGiessenGermany
  4. 4.Department of Visceral, Transplant and Thoracic Surgery, Center of Operative MedicineInnsbruck Medical UniversityInnsbruckAustria
  5. 5.Department of Thoracic SurgeryKlinikum BogenhausenMunichGermany

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