The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis. Issue 4 (5th April 2023)

• Record Type: Journal Article
• Authors: Tanaka, Yugo; Maniwa, Yoshimasa; Sugio, Kenji; Okamoto, Tatsuro; Nibu, Ken-Ichi; Omori, Takashi; Endo, Shunsuke; Kuwano, Hiroyuki; Chida, Masayuki; Toh, Yasushi; Okada, Morihito; Shiotani, Akihiro; Yoshino, Ichiro
• Is Part Of: Interdisciplinary cardiovascular and thoracic surgery. Volume 36:Issue 4(2023)
• Publication Date: 2023-04-05
• Subjects: Descending necrotizing mediastinitis -- Mediastinal drainage -- Thoracotomy -- Video-assisted thoracic surgery
• DOI: 10.1093/icvts/ivad053
• Languages: English
• ISSNs: 2753-670X

Abstract

Abstract: OBJECTIVES: Thoracotomy is a reliable approach for descending necrotizing mediastinitis (DNM), and the use of video-assisted thoracic surgery (VATS), a minimally invasive procedure, has been increasing. However, which approach is more effective for DNM treatment is controversial. METHODS: We analysed patients who underwent mediastinal drainage via VATS or thoracotomy, using a database with DNM from 2012 to 2016 in Japan, which was constructed by the Japanese Association for Chest Surgery and the Japan Broncho-esophagological Society. The primary outcome was 90-day mortality, and the adjusted risk difference between the VATS and thoracotomy groups using a regression model, which incorporated the propensity score, was estimated. RESULTS: VATS was performed on 83 patients and thoracotomy on 58 patients. Patients with a poor performance status commonly underwent VATS. Meanwhile, patients with infection extending to both the anterior and posterior lower mediastinum frequently underwent thoracotomy. Although the postoperative 90-day mortality was different between the VATS and thoracotomy groups (4.8% vs 8.6%), the adjusted risk difference was almost the same, −0.0077 with 95% confidence interval of −0.0959 to 0.0805 ( P = 0.8649). Moreover, we could not find any clinical and statistical differences between the 2 groups in terms of postoperative 30-day and 1-year mortality. Although patients who underwent VATS had higher postoperative complication (53.0% vs 24.1%) and reoperation (37.9% vs 15.5%) rates than those who underwent thoracotomy, the complications were not serious and most could be treated with reoperation and intensive care. CONCLUSIONS: The outcome of DNM treatment does not depend on thoracotomy or VATS. Abstract : Descending necrotizing mediastinitis (DNM) is a serious infection that spreads from the neck, oral cavity and pharynx to the mediastinum.