VATS debridement for acute MRSA empyema after lobectomy for lung cancer

Abstract

A 74-year-old man with lung cancer was treated surgically by left lower lobectomy by video-assisted thoracoscopic surgery (VATS), and the early post-operative course was uneventful. After the threads of the thoracic drain site were removed on the 11th postoperative day, the wound opened and serous fluid discharged from the thoracic cavity, and the wound was re-sutured. A few days later, a spike fever with left pleural effusion appeared. Methicillin-Resistant Staphylococcus Aureus was positive in the culture of the pleural effusion. After chest tube drainage and antibiotics administrations failed to control the infection, re-operation by VATS was performed 25 days after the first surgery. All the fibrous thin septa in the multi-loculated cavities of empyema were debrided in order to form a single cavity for better drainage. Postoperative course after the second operation was uneventful, and the thoracic tube was removed 10 days later. VATS debridement is less invasive and very effective as a surgical approach for acute empyema after lobectomy.