Guidelines for the treatment of empyema (The Japanese Association for Chest Surgery)

Yuji Shiraishi¹, Mitsugu Omasa², Shinichi Yamashita³, Yoon Hyung-Eun⁴, Masayuki Tanahashi⁵, Takeshi Fukami⁶, Shinichi Tokyooka⁷, Yasuhisa Ode⁸, Tatsuro Okamoto⁹, Takashi Shiraishi¹⁰, Yasushi Shintani¹¹, Yasuhiro Hida¹², Sumiko Maeda¹³, Isao Matsumoto¹⁴, Yuichi Sakairi¹⁵, Mariko Fukui¹⁶, Katsuhiro Okuda¹⁷, Masanori Tsuchida¹⁸, Akira Iyoda¹⁹, Hisashi Saji^{20

21}, Ichiro Yoshino^{15

22

23}

Affiliations

¹ Section of Chest Surgery, Fukujuji Hospital, Japan Anti Tuberculosis Association, Kiyose, Tokyo, Japan.
² Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.
³ Department of Thoracic and Breast Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
⁴ Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
⁵ Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
⁶ Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Meguro, Tokyo, Japan.
⁷ Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
⁸ Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
⁹ Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
¹⁰ Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
¹¹ Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
¹² Advanced Robotic and Endoscopic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan.
¹³ Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
¹⁴ Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan.
¹⁵ Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹⁶ Department of General Thoracic Surgery, Juntendo University Hospital of Medicine, Bunkyo, Tokyo, Japan.
¹⁷ Departments of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
¹⁸ Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
¹⁹ Division of Chest Surgery, Department of Surgery, Toho University, Ota, Tokyo, Japan. aiyoda@med.toho-u.ac.jp.
²⁰ Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. hisashisaji@gmail.com.
²¹ Chief of Committee for Guideline Assessment, The Japanese Association for Chest Surgery, Kyoto, Japan. hisashisaji@gmail.com.
²² International University of Health and Welfare Narita Hospital, Narita, Japan.
²³ The Japanese Association for Chest Surgery, Kyoto, Japan.

PMID: 39969668
DOI: 10.1007/s11748-025-02119-0

Practice Guideline

Guidelines for the treatment of empyema (The Japanese Association for Chest Surgery)

Yuji Shiraishi et al. Gen Thorac Cardiovasc Surg. 2025 May.

. 2025 May;73(5):312-327.

doi: 10.1007/s11748-025-02119-0. Epub 2025 Feb 19.

Authors

Affiliations

¹ Section of Chest Surgery, Fukujuji Hospital, Japan Anti Tuberculosis Association, Kiyose, Tokyo, Japan.
² Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.
³ Department of Thoracic and Breast Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
⁴ Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
⁵ Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
⁶ Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Meguro, Tokyo, Japan.
⁷ Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
⁸ Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
⁹ Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
¹⁰ Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
¹¹ Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
¹² Advanced Robotic and Endoscopic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan.
¹³ Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
¹⁴ Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan.
¹⁵ Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹⁶ Department of General Thoracic Surgery, Juntendo University Hospital of Medicine, Bunkyo, Tokyo, Japan.
¹⁷ Departments of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
¹⁸ Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
¹⁹ Division of Chest Surgery, Department of Surgery, Toho University, Ota, Tokyo, Japan. aiyoda@med.toho-u.ac.jp.
²⁰ Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. hisashisaji@gmail.com.
²¹ Chief of Committee for Guideline Assessment, The Japanese Association for Chest Surgery, Kyoto, Japan. hisashisaji@gmail.com.
²² International University of Health and Welfare Narita Hospital, Narita, Japan.
²³ The Japanese Association for Chest Surgery, Kyoto, Japan.

PMID: 39969668
DOI: 10.1007/s11748-025-02119-0

Abstract

This article translates the guidelines for the treatment of empyema established by the Japanese Association of Chest Surgery in 2023 from Japanese to English. These guidelines were developed by the Working Group on Guidelines for the Treatment of Empyema of our society, involving the establishment of clinical questions, conducting systematic reviews in accordance with the MINDS (Medical Information Distribution Service) Manual for Guideline Development 2020 version 3.0 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system, and determining the levels of recommendations. Furthermore, external evaluators provided assessments. Subsequently, the guidelines were finalized after receiving public comments from the members of the society. Even in the current era of advanced antibiotic therapy, empyema remains difficult to treat. However, the specific guideline for the treatment of empyema lacks in our country. Each institution is conducting clinical practices in its own way. Therefore, aiming to standardize the treatment of empyema, we have developed a practice guideline of empyema treatment. The pathophysiology of empyema is diverse, so empyema is classified into acute, chronic, and postoperative empyema. The recommended surgical treatment for each type of empyema is described, being categorized by the strength of recommendation, strength of evidence, and consensus rate.

Keywords: Decortication; Empyema; Open window thoracostomy; Surgery.

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Conflict of interest statement

Declarations. Conflict of interest: Ex: AI reports grants from Eli Lilly. ST reports grants from TAIHO, Astellas Pharma, and MSD. TO reports grants from MSD, Chugai-pharm, DAIICHI SANKYO COMPANY, Pfizer, and AnHeart Therapeutics. YS, MF, KO, YS, YH, MO, MT, TF, SY, MT, HS, and IY have no conflicts of interest to declare in this article.

References

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1. Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema? Interact Cardiovasc Thorac Surg. 2010;11:171–7. - PubMed - DOI

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Guidelines for the treatment of empyema (The Japanese Association for Chest Surgery)

Affiliations

Guidelines for the treatment of empyema (The Japanese Association for Chest Surgery)

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

Supplementary concepts

LinkOut - more resources

Full Text Sources