The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis

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 analyzed patients who underwent mediastinal drainage via VATS or thoracotomy, using a database with DNM from 2012 to 2016 in Japan, which was constructed bv 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 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 two 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.

Video-assisted thoracic surgery drainage is feasible and safe for acute necrotizing mediastinitis: a retrospective cohort study

“…The results showed that thoracotomy was more frequently chosen for patients with esophageal perforation. The postoperative outcomes of the two groups were compared, and it was found that these outcomes were similar between the two groups, which was consistent with a previous report ( 13 ).…”

“…However, with the development of video-assisted thoracic surgery (VATS), numerous diseases are now being treated with VATS. There was one study which compared thoracotomy and VATS for treating patients with DNM ( 13 ), but there is no accepted consensus concerning which approach is preferred. We thus collected the data of patients with ANM treated with surgery over a 9-year period at our center and compared the outcomes of VATS-treated patients with those of thoracotomy-treated patients.…”

Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible?

“…VATS: video-assisted thoracoscopic surgery. * According to the Systematic Classification of Morbidity and Mortality After Thoracic Surgery (Seely AJE et al [14,16]).…”

“…In the literature, the largest series of patients that underwent VATS treatment for DNM was analyzed by Tanaka et al [16]. In their series of patients suffering from DNM, 83 patients underwent VATS, and 58 patients underwent thoracotomy.…”

“…The feasibility of VATS mediastinal drainage does not imply that all cases of DNM can be treated with VATS. If sufficient drainage of the mediastinum cannot be achieved through minimally invasive surgery, conversion to thoracotomy should be considered [16,31].…”