| Introduction: Introduction: The optimal treatment of empyema thoracis is
still debatable between academics and surgeons. This study reviews advantages and disadvantages of video-assisted thoracoscopic surgery (VATS) and
open thoracotomy decortication (OTD) considering outcomes of empyema
thoracis.
Materials and methods: A descriptive Boolean query was used for searching
three databases to extract the published studies up to 27 March 2017. The
outcomes of VATS and OTD were extracted and assessed by random-effects
model of meta-analysis. The Egger’s test and trim-and-fill method were used
for analyzing publication bias, and, meta-regression and subgroup analyses
were done for determining heterogeneity.
Results: A total of 2219 patients, from 13 studies, meeting the inclusion
criteria were selected and subjected to further analyses. Of 2219 patients,
1120 were treated by VATS and the remaining were subjected to OTD.
During VATS, 252 patients were converted to OTD. Forest plots showed that
VATS was far superior in terms of incidence of duration of hospital stay
and operative time (SMDs = 1.189, 1.565; p < 0.001, < 0.001) compared to
OTD. Mortality, prolonged air leakage, wound infection, and recurrence rates
(ORs = 1.234, 2.564, 1.363, 1.962; p = 0.576, 0.077, 0.0692, 0.4) had no advantages for both procedures while failure or conversion rate (OR = 0.198,
p < 0.001) of VATS was more than those of OTD.
Conclusions: The results of the current research suggest no trends of superior outcomes with VATS in the treatment of empyema thoracis. Hence,
VATS and OTD could be recommended as treatments for empyema thoracis. |