title: EACTS expert consensus statement for surgical management of pleural empyema.
abstract: Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK marco.scarci@nhs.net.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarci
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK.
authors.forename: Udo
authors.initials: U
authors.lastname: Abah
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Page
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Waller
authors.affiliation: Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: van Schil
authors.affiliation: Department of Cardiothoracic Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Melfi
authors.affiliation: Division of General Thoracic Surgery, Berne University Hospital, Berne, Switzerland.
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Schmid
authors.affiliation: Unit of Thoracic Surgery, Evangelismos Hospital, Athens, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Athanassiadi
authors.affiliation: Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Sousa Uva
authors.affiliation: Unit of Thoracic Surgery, Az. Osped. S. Camillo Forlanini, Carlo Forlanini Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
mesh_terms: D000328:Adult; D002648:Child; D032921:Consensus; D016724:Empyema, Pleural / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D020775:Thoracic Surgery, Video-Assisted
keywords: Empyema; Pleural infection; Video-assisted thoracic surgery