{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:36:49Z","timestamp":1792816609699,"version":"4.5.0"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":235,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Empyema secondary to upper gastrointestinal (GI) leakage after surgical or endoscopic intervention is a rare but severe complication for which the role of video\u2010assisted thoracoscopic surgery (VATS) remains unclear. This study evaluated the short\u2010term safety and procedural feasibility of VATS, using the outcomes of VATS for parapneumonic empyema as a clinical benchmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed patients undergoing surgery for empyema at two affiliated institutions (2015\u20132026). Patients with empyema secondary to upper GI leakage after surgical or endoscopic intervention were compared with those with acute Stage II\u2013III parapneumonic empyema. The primary endpoint was 30\u2010day mortality. Perioperative outcomes, including VATS completion, re\u2010operation, postoperative hospital stay, and microbiological findings, were also compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 257 empyema surgical records, 142 patients were analyzed (GI leakage group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911; parapneumonic group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009131). The recorded interval from symptom onset to VATS was shorter in the GI leakage group (median 3 vs. 18\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and the incidence of multiloculated empyema on preoperative CT was lower (9.1% vs. 48.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). Re\u2010operation was more frequent in the GI leakage group (36.4% vs. 5.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), and postoperative hospital stay was longer (median 34 vs. 16\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). No 30\u2010day deaths occurred in the GI leakage group, compared with 6 deaths (4.6%) in the parapneumonic group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Empyema secondary to upper GI leakage after surgical or endoscopic intervention followed a refractory clinical course despite intervention before advanced pleural organization. VATS may be a feasible component of multidisciplinary source\u2010control management, although frequent re\u2010intervention may be required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70370","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:10:46Z","timestamp":1787616646000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Video\u2010Assisted Thoracoscopic Surgery for Empyema Secondary to Upper Gastrointestinal Leakage After Surgical or Endoscopic Intervention: A Multicenter Comparative Study"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2197-6219","authenticated-orcid":false,"given":"Yo","family":"Tsukamoto","sequence":"first","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1168-0163","authenticated-orcid":false,"given":"Takeo","family":"Nakada","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4264-3528","authenticated-orcid":false,"given":"Saki","family":"Tsubouchi","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Kashiwa Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Suyama","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maki","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Kashiwa Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takamasa","family":"Shibazaki","sequence":"additional","affiliation":[{"name":"Department of Surgery The Jikei University Hospital  Tokyo 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