EACTS expert consensus statement for surgical management of pleural empyema

Area of Science:

• Thoracic Surgery
• Infectious Diseases
• Pulmonology

Background:

• Pleural infection is a common clinical issue with significant morbidity and mortality.
• Recent treatment advancements require better clinical implementation.
• The European Association for Cardio-Thoracic Surgery (EACTS) provides guidelines for managing pleural infections.

Purpose of the Study:

• To review the latest evidence and concepts in pleural infection management.
• To cover surgical aspects of empyema in adults, children, and post-pneumonectomy empyema (PPE).
• To guide clinical practice and stimulate further research in pleural infection treatment.

Main Methods:

• Comprehensive review of available scientific evidence.
• Focus on surgical treatment strategies for different types of empyema.
• Analysis of outcomes for various interventions, including video-assisted thoracoscopic surgery (VATS).

Main Results:

• Stage 1 empyema requires prompt chest tube drainage.
• Surgical debridement or decortication (VATS) benefits Stage 2/3 empyema patients over tube thoracostomy alone.
• Primary operative approach is effective in children, reducing mortality and hospital stay.
• Minimally invasive VATS is effective for uncomplicated PPE; open surgery for PPE with bronchopleural fistula (BPF).

Conclusions:

• VATS is crucial in managing pleural empyema.
• Treatment choice depends on empyema stage, patient factors, and surgeon preference.
• Evidence supports prompt surgical intervention for improved outcomes in pleural infections.