초록접수 현황
| 20F-222 | 구연 발표 |
Is it safe and effective to attempt early thoracoscopic surgery without medical stabilization in patients with complicated parapneumonic effusion or empyema?
Sung Jun Chung1, Hyo Jun Jang2, Hyun Lee1, Jun Ho Lee2, Won Sang Chung2, Dong Won Park1, Sang-Heon Kim1, Jang Won Sohn1, Ho Joo Yoon1 and Hyuck Kim2
1 Department of Chest Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
2 Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
Purpose : According to recent international guidelines, treatment of complicated parapneumonic effusion (CPE) is changing from medical treatment to early thoracoscopic surgery as initial treatment. This study compared the outcomes of early surgery and delayed surgery.
Methods : We retrospectively reviewed 40 patients who underwent surgery for CPE from January of 2013 to May of 2020. The early surgery group (ESG) was defined as planning surgery for initial treatment and delayed surgery group (DSG) defined as planning surgery after more than 1 week of medical management.
Results : Among 40 patients, 22 patients received early surgery, and 18 patients received delayed surgery. The preoperative day from identification of CPE to surgery was shorter in ESG (2.5days vs 10.5days, p<0.001). Preoperative C-reactive protein was higher in ESG (23.1 vs 8.8, p<0.001). Stage III empyema was prevalent in DSG (27.3% vs 76.9%, p=0.004). Operative time was longer in DSG (87.5min vs 132.5min, p=0.004). Intraoperative blood loss was more in DSG (200ml vs 750ml, p=0.009). The hospital stay was longer in DSG (18.5days vs 30.0days, p<0.001). The complication rate (31.8% vs 33.3%) and in-hospital mortality rate (4.5% vs 5.6%) were not different between groups.
Conclusion : The strategy of delayed surgery might make patients stable, however, operation more difficult and hospital stay longer. Despite the short period of medical management, early thoracoscopic surgery could effectively control CPE without increasing morbidity and mortality.
Methods : We retrospectively reviewed 40 patients who underwent surgery for CPE from January of 2013 to May of 2020. The early surgery group (ESG) was defined as planning surgery for initial treatment and delayed surgery group (DSG) defined as planning surgery after more than 1 week of medical management.
Results : Among 40 patients, 22 patients received early surgery, and 18 patients received delayed surgery. The preoperative day from identification of CPE to surgery was shorter in ESG (2.5days vs 10.5days, p<0.001). Preoperative C-reactive protein was higher in ESG (23.1 vs 8.8, p<0.001). Stage III empyema was prevalent in DSG (27.3% vs 76.9%, p=0.004). Operative time was longer in DSG (87.5min vs 132.5min, p=0.004). Intraoperative blood loss was more in DSG (200ml vs 750ml, p=0.009). The hospital stay was longer in DSG (18.5days vs 30.0days, p<0.001). The complication rate (31.8% vs 33.3%) and in-hospital mortality rate (4.5% vs 5.6%) were not different between groups.
Conclusion : The strategy of delayed surgery might make patients stable, however, operation more difficult and hospital stay longer. Despite the short period of medical management, early thoracoscopic surgery could effectively control CPE without increasing morbidity and mortality.
첨부파일 : 2020 농흉 가을학회 테이블.docx
책임저자: Hyo Jun Jang
Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
발표자: Hyo Jun Jang, E-mail : rgo38@naver.com