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

Lin-Chuan Liang; Zhi-Yu Peng; Hua-Hang Lin; Ke Zhou; Jie Cao; Zhao-Kang Huang; Ze-Tao Liu; Jian-Dong Mei

doi:10.21037/jtd-23-845

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

J Thorac Dis. 2023 Nov 30;15(11):5992-5999. doi: 10.21037/jtd-23-845. Epub 2023 Oct 23.

Authors

Lin-Chuan Liang^#^{1

2}, Zhi-Yu Peng^#^{1

2}, Hua-Hang Lin^{1

2}, Ke Zhou^{1

2}, Jie Cao^{1

2}, Zhao-Kang Huang^{1

2}, Ze-Tao Liu^{1

2}, Jian-Dong Mei^{1

2}

Affiliations

¹ Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
² Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.

^# Contributed equally.

Abstract

Background: Acute necrotizing mediastinitis (ANM) is a severe infection of the mediastinal loose connective tissue. Traditionally, it has been treated with thoracotomy, but video-assisted thoracic surgery (VATS) is been increasingly used in patients with this condition. This study aimed to compare the outcomes of VATS and open thoracotomy in treating ANM.

Methods: The medical records of patients with ANM who underwent surgery between March 2012 and April 2021 were retrieved. A retrospective screening was conducted based on clinical characteristics, bacterial pathogens, surgical approach, and outcomes. The patients were divided into a VATS group and an open thoracotomy (Open) group. The patient characteristics and surgical outcomes of the two groups were summarized and compared.

Results: A total of 64 cases were enrolled in this study, including 48 in the VATS group (75%) and 16 in the Open group (25%). The most common site of infection was the neck (n=26, 40.6%). Streptococcus constellatus and Acinetobacter baumannii (A. baumannii) were the most frequently found pathogens in secretion culture. In sputum culture, the most common pathogens were Klebsiella pneumonia and A. baumannii. Postoperative outcomes, including blood transfusion (33.3% vs. 43.8%; P=0.45), duration of postoperative drainage {14 [1-47] vs. 17 [4-54] days; P=0.15}, length of antibiotic medication {14.5 [1-54] vs. 18 [4-54] days; P=0.29}, admission to intensive care unit (ICU) (87.5% vs. 75.0%; P=0.43), length of ICU stay {5 [1-58] vs. 8.5 [1-37] days; P=0.20}, postoperative hospital stay {17 [2-61] vs. 21 [5-56] days; P=0.22}, reoperation rate (12.5% vs. 6.25%; P=0.82), and mortality rate (14.6% vs. 12.5%; P>0.99) were comparable between the two groups.

Conclusions: ANM treated by both the VATS and open approach had comparable outcomes. Therefore, VATS is a viable option for patients with ANM.

Keywords: Acute necrotizing mediastinitis (ANM); outcomes; thoracotomy; video-assisted thoracic surgery (VATS).