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Multiport Video-assisted Thoracoscopic Surgery in Stage III Empyema Thoracis—a Case Series Analysis of a Cohort of 128 Patients from a Tertiary Care Centre in Eastern India

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Abstract

Clinico-patho-physiologically, there is a considerable overlap in stages II and III empyema thoracis (ET) (Table 1). Video-assisted thoracoscopic surgical decortication (VATSD) and open decortication (OD) both have been used in stage III ET when surgical intervention was required in patients not responding to chest tube/pigtail catheter drainage and/or antibiotic therapy. This study was an analysis of a cohort of 128 consecutive patients of stage III ET operated upon in a tertiary care centre from April 2015 to July 2021 by a single surgeon. Demographic and clinical details were analysed. VATSD was successful in 80/128 patients (62.5%) of stage III ET. Forty-two patients (32.8%) required elective OD. Six patients (6/86 = 6.98%) were converted from VATSD to OD. While head-to-head comparison was problematic in the two unmatched groups, we found that operating time was longer in VATSD than in the OD group contrary to recent published literature probably because of a higher (55%) prevalence of pulmonary tuberculosis in that group. Other discriminators (Table 2) included ICD duration less in VATSD group (median 6 days for OD, versus 5.5 days for VATSD, p 0.034), length of post-operative stay lower in VATSD group (median 7 days for OD and 6.5 days for VATSD, p 0.018). Post-operative pain on post-operation day (POD) 1 was also less in VATSD (p < 0.0001) and POD 5 (p < 0.0001) in VATSD patients. We conclude that VATSD may be an effective and safe first surgical option for stage III ET with less post-operative discomfort, reduced length of hospital stay and fewer post-operative complications in most patients. While our study reflects a real-world scenario, multicentric randomised control trials (RCTs) need to be undertaken across geographies for changes in the guidelines and recommendations for the treatment of stage III ET. In the consensus guidelines of the American Association of Thoracic Surgery (AATS), VATSD for stage III ET is a class IIA recommendation.

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Acknowledgements

Ms. Paramita Auddya Ghorai, Chief Clinical Statistician, NH RTIICS, Kolkata.

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Authors and Affiliations

  1. Department of Thoracic & Vascular Surgery, Rabindranath Tagore International Institute Of Cardiac Sciences, 124, Mukundapur, E.M. Bypass, Kolkata, 700099, India

    Amitabha Chakrabarti, Manujesh Bandyopadhyay & Unmesh Chakraborty

  2. Kolkata, India

    Amitabha Chakrabarti, Manujesh Bandyopadhyay & Unmesh Chakraborty

  3. HOD Department of CTVS KPC Medical College Kolkata, Kolkata, India

    Amitabha Chakrabarti

  4. Thoracic & Vascular Surgeon NH RTIICS, Kolkata, India

    Manujesh Bandyopadhyay

  5. DrNB (Doctorate of National Board) Resident, Cardio Thoracic & Vascular Surgery, NH RTIICS, Kolkata, India

    Unmesh Chakraborty

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  1. Amitabha Chakrabarti
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Correspondence to Amitabha Chakrabarti.

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Chakrabarti, A., Bandyopadhyay, M. & Chakraborty, U. Multiport Video-assisted Thoracoscopic Surgery in Stage III Empyema Thoracis—a Case Series Analysis of a Cohort of 128 Patients from a Tertiary Care Centre in Eastern India. Indian J Surg 85 (Suppl 2), 417–423 (2023). https://doi.org/10.1007/s12262-023-03747-7

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  • DOI: https://doi.org/10.1007/s12262-023-03747-7

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