Prognosis and Interventions for Acute Empyema with Carcinomatous Pleuritis in Patients with Stage IV Lung Cancer

Objective. Reports of acute empyema with carcinomatous pleuritis in patients with stage IV lung cancer are rare. There are few cases in which the infection is successfully controlled and therapeutic intervention for cancer is possible. Study Design. We retrospectively reviewed patients who had undergone surgery for acute empyema with carcinomatous pleuritis with stage IV lung cancer at two affiliated institutions from 2015 to 2023 to determine the prognosis of their disease. Result. Of the 197 patients who underwent surgery for empyema during the period, 8 (4.1%) had acute empyema with carcinomatous pleuritis. The median age of the patients was 71 (interquartile range [IQR] 66-75) years, and 7 (87.5%) of them were male. The median duration from onset to surgery was 21 (IQR, 5-37) days. Four patients developed acute empyema due to retrograde infection during thoracic drainage for pleuritis of lung cancer. In the remaining 4 patients, after surgery for acute empyema, a pathological examination confirmed the diagnosis of carcinomatous pleuritis. The median duration of postoperative drainage was 13 (IQR, 11-14) days, whereas the median postoperative hospital stay was 24 (IQR, 20-48) days. Overall, 7 of the 8 patients showed an improvement in inflammation and fever; therefore, their drainage tubes were removed. The median survival following surgery for empyema was 153 (IQR, 121-223) days. Only 1 death was reported within 90 days after surgery. Conclusion. Although the prognosis of acute empyema with carcinomatous pleuritis in patients with stage IV lung cancer is very poor, surgical intervention can control the infection. A pathological examination of the abscess wall and intraoperative debridement should be performed. The possibility of occult cancer should be considered during surgery for acute empyema.