Implications of Pneumoconiosis on Surgical Management of Empyema Thoracis: A Systematic Review

Abstract

Background: Pneumoconiosis, including silicosis, asbestosis, and coal workers' pneumoconiosis, cause chronic pulmonary and pleural fibrosis that may complicate the surgical treatment of empyema thoracis.

Objective: To systematically evaluate the literature for evidence on how pneumoconiosis affects the surgical management, intraoperative challenges, and outcomes in patients undergoing surgical treatment for empyema thoracis.

Methods: A systematic search of PubMed, Embase, and Scopus was conducted for the period January 2000 to December 2024. Keywords used included combinations of “pneumoconiosis,” “silicosis,” “asbestosis,” “coal workers’ pneumoconiosis,” “empyema thoracis,” and “surgery.” The review included clinical studies reporting surgical interventions for empyema in patients with any type of pneumoconiosis. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS).

Results: Eleven studies were included, comprising eight retrospective cohort studies, two case-control studies, and one case series, encompassing approximately 290 patients. Pneumoconiosis was consistently associated with increased reliance on open thoracotomy over VATS, frequent pleural calcifications, and extensive adhesions, contributing to complex surgical fields, increased intraoperative bleeding (500–800 mL), and prolonged air leaks (>7 days in 35%). Postoperative complications such as respiratory failure and infections were also more common. Hospital stays ranged from 14 to 21 days. The 30-day mortality in this subgroup ranged from 6% to 12%.

Conclusion: Pneumoconiosis imposes significant challenges in the surgical management of empyema thoracis. Early identification, preoperative imaging, multidisciplinary management, and potentially modified surgical strategies are critical to improving patient outcomes.