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The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis

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 神戸大学

2023.04

概要

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.

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Values were presented as n (%). The unadjusted RD is the crude value. The adjusted RD including group and logit-transformed propensity scores was assessed using the regression formula.

CI: confidence interval; CVD: cardiovascular diseases; RD: risk difference; VATS: video-assisted thoracic surgery.

THORACIC NONONCOLOGY

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