Utility and Safety of Decortication Using Medical Thoracoscopy under Local Anesthesia Performed by Respiratory Physicians in Patients with Acute Pleural Empyema: A Single-center Retrospective Study

Objective Acute pleural empyema, defined as empyema diagnosed within three months of the onset, frequently affects patients with poor general health and often poses challenges for invasive treatments requiring general anesthesia. In addition, the number of respiratory surgeons was insufficient and unevenly distributed across urban base and core hospitals in Japan. Therefore, safe and effective therapeutic procedures that physicians can perform are required. Methods We retrospectively analyzed 28 patients with acute pleural empyema who underwent decortication using medical thoracoscopy under local anesthesia (DMT-LA) in our department. All procedures were performed by respiratory physicians at our institution. The "success" of DMT-LA was defined by meeting all of the following criteria: (i) absence of residual clinically significant pleural effusion, (ii) resolution of clinical signs of sepsis, (iii) normalization of serum C-reactive protein (CRP) levels and white blood cell counts, (iv) no requirement for additional interventions, and (v) maintenance of these conditions for at least one month following antibiotic treatment. Results Of the 28 patients, 21 met the criteria for success, yielding a success rate of 75.0%. Patients in the failure group were more likely to have an Eastern Cooperative Oncology Group-performance status of >3, stage III empyema, and high median serum CRP levels than those in the success group. Adverse events were observed in only one patient (3.4%) and involved prolonged sedative effects. Conclusion DMT-LA is a safe and effective therapeutic procedure that can be performed by respiratory physicians and provides a viable treatment option for acute pleural empyema, particularly in facilities without respiratory surgeons.