Expert consensus on a stepwise strategy for the surgical management of empyema based on pathological staging (2026 edition)
- VernacularTitle:基于病理分期的脓胸胸外科治疗阶梯化策略专家共识（2026版）
- Author:
Jichen QU
1
;
Yunjiu GOU
1
;
Guangyu CHEN
2
;
Yongfu ZHAI
3
;
Tinglong MA
4
;
Xiaogang ZENG
5
;
Feng JIN
6
;
Yanzheng SONG
7
;
Boxiong XIE
8
;
Minjie MA
9
;
Bin LI
10
;
Jiang FAN
11
Author Information
1. Department of Thoracic Surgery, Gansu Provincial People's Hospital, Lanzhou, 730030, P. R. China
2. Clinical Epidemiology Research Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200400, P. R. China
3. Department of Thoracic Surgery, Jiuquan Hospital of Shanghai General Hospital, Jiuquan, 735000, Gansu, P. R. China
4. Department of Thoracic Surgery, Heilongjiang Provincial Hospital for Infectious Diseases, Harbin, 150500, P. R. China
5. Department of Thoracic Surgery, Chengdu Public Health Clinical Medical Center, Chengdu, 610061, P. R. China
6. Department of Thoracic Surgery, Shandong Public Health Clinical Center, Jinan, 250102, P. R. China
7. Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Shanghai, 201508, P. R. China
8. Department of Thoracic Surgery, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, 200433, P. R. China
9. Department of Thoracic Surgery, The First Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730030, P. R. China
10. Department of Thoracic Surgery, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730030, P. R. China
11. Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200400, P. R. China
- Collective Name:Thoracic and Cardiovascular Surgery Branch of Gansu Medical Association, Thoracic Minimally Invasive Surgery Professional Committee of Shanghai Research-oriented Hospital Association
- Publication Type:Journal Article
- Keywords:
Empyema;
pathological staging;
video-assisted thoracoscopic surgery;
pleural decortication;
metagenomic next-generation sequencing;
perioperative management;
expert consensus
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(07):988-998
- CountryChina
- Language:Chinese
-
Abstract:
The surgical management of empyema (excluding those caused by mycobacterium tuberculosis and non-tuberculous mycobacteria) is rapidly evolving towards minimally invasive, precise, and stepwise approaches. The traditional three-stage classification (exudative, fibrinopurulent, and organizing) has limitations in guiding dynamic clinical decision-making. For the first time, this consensus explicitly identifies two critical junctures in the pathological progression of empyema: "early transformation" (stage Ⅰ to Ⅱ) and "late transformation" (stage Ⅱ to Ⅲ), and thereby constructs a corresponding "identification-early warning-intervention" stepwise therapeutic framework. The consensus emphasizes that proactive debridement via video-assisted thoracoscopic surgery should be performed during the early transformation phase to halt disease progression. Conversely, during the late transformation phase, therapeutic goals should be rationally adjusted to prioritize adequate drainage, avoiding futile pleural decortication. Moreover, the consensus underscores the pivotal role of precise perioperative etiological diagnosis (e.g. metagenomic nest-generation sequencing) and standardized anti-infective therapy. Integrating practical experiences from multiple thoracic surgery centers in China and relevant evidence-based literature, this consensus formulates recommendations on the precise definitions of staging, surgical indications for each phase, key technical points, perioperative management, and training systems. It aims to promote the standardized and individualized surgical management of empyema, ultimately optimizing patient prognosis.
