[Surgical treatment of empyema].

Empyema remains challenging for thoracic surgeons. This review covers surgical treatment of acute empyema, chronic empyema, and post-surgical empyema. For acute empyema, early surgical intervention, such as video assisted thoracoscopic debridement, is recommended when conventional chest tube drainage has failed. Radical treatment of chronic empyema includes removal of empyema sac (decortication with or without lung resection) and obliteration of empyema space with muscle flap, omental flap, or thoracoplasy. When bronchopleural fistula exists, the fistula should be closed. For patients who are not eligible for radical treatment, open window thoracostomy should be considered. The best treatment of empyema complicating pulmonary resection is prevention. Once empyema occurs, obliteration of empyema space is radical treatment. When empyema is associated with bronchopleural fistula, the fistula should be closed. Meticulously individualized approach based on patient's empyema holds the key to success.