The modern use of thoracoplasty

Our plain-English summary of The modern use of thoracoplasty, by R.A. Hopkins, R.M. Ungerleider, E.W. Staub, et al (The Annals of Thoracic Surgery, 1985).

The study

• Authors: R.A. Hopkins, R.M. Ungerleider, E.W. Staub, W.G. Young
• Journal: The Annals of Thoracic Surgery
• Published: 1985;40(2):181-7
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Thoracoplasty is a time-honored but, at present, rarely indicated procedure for reducing thoracic cavity volume. This study reviews a series of 30 patients treated with thoracoplasty over a 14-year period (1970 through 1983). Indications were to close a persistent pleural space in 28 patients and to tailor the thoracic cavity to accept diminished lung volume concomitant with a pulmonary resection in 2 patients. Persistent pleural space, often associated with a bronchopleural fistula (24 patients), occurred after operation in 19 patients: following pulmonary resection in 17 patients, resection of mesothelioma in 1 patient, and following decortication without resection in 1. In the remaining 9 patients with a persistent pleural space, problems developed from primary lung destruction due to tuberculosis (4 patients), postpneumonic empyema (1 patient), or as late infection of a residual pleural space many years after therapeutic pneumothorax and collapse therapy for tuberculosis (4 patients). The overall success rate of thoracoplasty in eliminating intrathoracic space problems was 73%. There were 3 deaths (10%) and 5 failures to heal, representing a 33% failure in the first half of the series (to 1976) and a 17% failure rate thereafter (1 death and 1 nonhealing patient). The primary underlying disease was tuberculosis in 23 patients, 8 of whom had concomitant aspergilloma and 1, atypical tuberculosis. The failures were analyzed and reviewed to clarify the principles for the successful use of thoracoplasty. It is concluded that thoracoplasty is a rarely required salvage-type procedure applicable to moderately debilitated patients in whom it is considered desirable to eliminate open drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

In plain English

This article reviewed the records and chest X-rays of all 30 patients who had thoracoplasty from 1970 through 1983 at Duke University Medical Center, the Durham Veterans Administration Hospital and the North Carolina Tuberculosis Sanatorium. Thoracoplasty is an operation that removes ribs to make the chest cavity smaller. The patients were 26 men and 4 women aged 26 to 71. Tuberculosis was the main underlying disease in 23 patients, and cancer was the main diagnosis in 3. Most operations were done to close an infected space left in the chest, often after earlier lung surgery. In one patient that space followed removal of a mesothelioma. The article does not say where that mesothelioma was and does not discuss asbestos. Eight of the 30 operations ended in death or failure: 3 patients died (10%) and 5 did not heal. The combined failure rate was 33% before 1976 and 17% afterward. The chest space problem was resolved in 73% of patients. The authors traced failures mainly to infection not being controlled beforehand and to spaces not being fully closed. The authors concluded that thoracoplasty is a rarely required salvage-type procedure for moderately debilitated patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of a surgical case series (patient records and chest X-rays)
• Who was studied: 30 patients (26 men, 4 women, aged 26 to 71) who had thoracoplasty from 1970 through 1983 at three hospitals in North Carolina (Duke University Medical Center, Durham Veterans Administration Hospital, North Carolina Tuberculosis Sanatorium at McCain). Tuberculosis was the primary disease in 23 patients and cancer in 3. One patient's operation followed resection of a mesothelioma.
• Exposure: Not an asbestos exposure study. What was studied was the surgical procedure thoracoplasty, in three types (conventional/Alexander, tailoring, and Schede). No fiber types or asbestos exposure are discussed.
• Main results:
  • Of the 30 operations, 8 resulted in death or failure. The combined failure and death rate was 27%: 33% before 1976 and 17% afterward.
  • There were 3 deaths among the 30 patients, an overall perioperative mortality of 10%.
  • Among the 19 patients treated for spaces left after surgery (including 1 after mesothelioma resection), there were 6 failures, 3 of which were deaths.
  • Among the 9 patients whose spaces were not caused by an operation, there was 1 failure.
  • Neither of the 2 patients who had tailoring thoracoplasty at the same time as lung resection did well.
  • Resolution of the chest space problems, with healing of bronchopleural fistulas and obliteration of the empyema, was achieved in 73% of patients.
  • The authors found two main causes of failure: infection not fully controlled before the operation, and the space not being completely closed.
• The authors' conclusion: The authors concluded that thoracoplasty is a rarely required salvage-type procedure suited to moderately debilitated patients in whom it is desirable to eliminate open drainage.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Empyema, Pneumothorax, Intrathoracic.

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