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. 2024 Apr 22;13(8):2440.
doi: 10.3390/jcm13082440.

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

Beatrice Leonardi  1 , Giovanni Natale  1 , Caterina Sagnelli  2 , Antonio Marella  1 , Francesco Leone  1 , Francesca Capasso  1 , Noemi Maria Giorgiano  1 , Davide Gerardo Pica  1 , Rosa Mirra  1 , Vincenzo Di Filippo  1 , Gaetana Messina  1 , Giovanni Vicidomini  1 , Giovanni Motta  3 , Eva Aurora Massimilla  3 , Gaetano Motta  3 , Erino Angelo Rendina  4 , Valentina Peritone  4 , Claudio Andreetti  4 , Alfonso Fiorelli  1 , Antonello Sica  5
Affiliations

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

Beatrice Leonardi et al. J Clin Med. .

Abstract

Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy.

Keywords: descending necrotizing mediastinitis; mediastinitis; otolaryngology; thoracic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cervical MRI image showing a neck abscess in a 44-year-old patient with DNM, treated with right cervicotomy and VATS mediastinal drainage.
Figure 2
Figure 2
(A–C): Chest CT of a 43-year-old patient showing mediastinal involvement of DNM. The patient was treated with left cervicotomy and underwent a left thoracotomy for mediastinal drainage.
Figure 3
Figure 3
Mediastinal drainage through right thoracotomy in a patient suffering from DNM. (A): Exploration of mediastinum showing pericardial thickening and mediastinal abscess. (B): Anterior mediastinal exploration and debridement. (C,D): Dissection of necrotic and purulent tissue in the anterior mediastinum.
Figure 4
Figure 4
(A,B): Intraoperative images of anterior mediastinal dissection during right triportal VATS for DNM.
See this image and copyright information in PMC

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