Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review. We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of “A. Cardarelli” Hospital, in Campobasso, Molise, Italy. A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as “adults,” 14 (48.28%) patients were older than 70 years old, identified as “elderly.” No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery. In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients.

中文翻译：

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单孔VATS治疗II期胸膜积脓：成人和老年患者安全有效的方法——单中心经验和文献回顾

胸膜脓胸 (PE) 是一种常见疾病，具有较高的发病率和死亡率。手术方法是大多数 II-III 期 PE 患者的标准治疗方法。在过去的几年里，微创外科革命也涉及胸外科，在安全性和有效性方面取得了相同的结果，并结合了更好的疼痛管理和早期出院。本研究的目的是通过我们在单孔视频辅助胸腔镜 (u-VATS) 方面的经验证明其治疗 II 期 PE 的方法的有效性和安全性。作为次要终点，我们将通过文献回顾评估成人和老年患者中 u-VATS 适应症的不同模式。我们回顾了我们从 2018 年 11 月到 2022 年 2 月前瞻性收集的 u-VATS 程序数据库，在我们“A. Cardarelli”医院，位于意大利莫利塞的坎波巴索。共有 29 名患者接受了 II 期 PE 的 u-VATS。15 名（51.72%）患者年龄小于 70 岁，被确定为“成人”，14 名（48.28%）患者年龄超过 70 岁，被确定为“老年人”。没有发现死亡。总人群的平均手术时间为 104.68 ± 39.01 分钟。老年组的手术时间更长（115±53.15 分钟）（p = 0.369）。成人比老年组更早拔除胸管（5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038）。成人组的住院时间 (LOS) 较短（6.44 ± 2.35 对 12.29 ± 6.96 p = 0.033）。通过仪器日常生活活动 (IADL) 量表评估的患者在手术后恢复了正常的日常生活活动。此外，u-VATS 方法似乎是安全有效的，可确保降低老年患者进展为 III 期 PE 的风险，同时降低复发风险和脓毒症并发症。提倡进一步的比较多中心分析来确定 u-VATS 方法在成人和老年患者 PE 治疗中的作用。