{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:09:53Z","timestamp":1788948593084,"version":"build-2803163510"},"reference-count":20,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: While non-specific pleural empyema in children can be successfully managed with conservative drainage and thoracentesis in 80\u201384% of cases, tuberculous pleural empyema (TB empyema) exhibits high resistance and frequently requires extensive thoracic surgery. The choice of surgical scope depends directly on disease stage and secondary complications. Methods: We conducted a retrospective cohort study of 85 pediatric patients (aged 4 to 17 years) with confirmed TB empyema treated between 1984 and 2022, and followed until 2025. Disease staging followed a predefined adaptation of the American Association for Thoracic Surgery (AATS) consensus classification. The study adhered strictly to STROBE guidelines, incorporating temporal stratification across three historical eras and standardized Clavien\u2013Dindo complication reporting. This study describes a 38-year surgical experience at a tertiary pediatric phthisiosurgical center; non-operated patients successfully cured with exclusive chemotherapy were excluded. Results: Stage I empyema was identified in three patients, Stage II in seven, and Stage III in 75 patients (79 total procedures). Stage I\u2013II patients underwent video-assisted thoracoscopic (VATS) debridement. In Stage III, advanced reconstructive interventions were required (39 VATS pleurectomies, 21 segmental resections, eight pleuropneumonectomies, six lobectomies, two thoracomyoplasties, two open resections, and one bronchus occlusion). Postoperative complications occurred in two patients (2.35% patient-level; categorized as Clavien\u2013Dindo Grade IIIa and Grade IIIb), presenting as delayed lung re-expansion managed via secondary minor interventions. Overall 30-day postoperative mortality was 0.0%. Over a median follow-up of 48 months (database lock: 31 December 2025; 97.65% 36-month completeness), zero disease recurrences were documented (0.0%). Conclusion: In this tertiary surgical cohort, combined management incorporating stage-dependent surgical intervention achieved durable clinical cure. Early VATS debridement represents an effective option for Stage I\u2013II patients who fail initial drainage, potentially reducing progression to a rigid fibrothorax and the subsequent need for extensive pulmonary resections.<\/jats:p>","DOI":"10.3390\/pathogens15090926","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:39:47Z","timestamp":1788363587000},"page":"926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Treatment of Tuberculous Pleural Empyema in Children and Adolescents: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1946-5193","authenticated-orcid":false,"given":"Dmitry B.","family":"Giller","sequence":"first","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Alexandr D.","family":"Chuishchev","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"},{"name":"Moscow Regional Clinical Anti-Tuberculosis Dispensary, 127055 Moscow Oblast, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5948-8643","authenticated-orcid":false,"given":"Inga I.","family":"Enilenis","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2982-6992","authenticated-orcid":false,"given":"Vadim V.","family":"Koroev","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2169-1114","authenticated-orcid":false,"given":"Oleg S.","family":"Kesaev","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Galina V.","family":"Shcherbakova","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8140-3906","authenticated-orcid":false,"given":"Patimat G.","family":"Gadzhieva","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7488-5281","authenticated-orcid":false,"given":"Ludmila P.","family":"Severova","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"}]},{"given":"Nadezhda I.","family":"Klevno","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"},{"name":"National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Ministry of Health of the Russian Federation, 127473 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-545X","authenticated-orcid":false,"given":"Alexey V.","family":"Kazakov","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia"},{"name":"National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Ministry of Health of the Russian Federation, 127473 Moscow, Russia"},{"name":"Department of Phthisiopulmonology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"given":"Olga P.","family":"Frolova","sequence":"additional","affiliation":[{"name":"Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. 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