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Leonardi B, Natale G, Sagnelli C, Marella A, Leone F, Capasso F, Giorgiano NM, Pica DG, Mirra R, Di Filippo V, Messina G, Vicidomini G, Motta G, Massimilla EA, Motta G, Rendina EA, Peritone V, Andreetti C, Fiorelli A, Sica A. Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible? J Clin Med 2024; 13:2440. [PMID: 38673713 PMCID: PMC11051203 DOI: 10.3390/jcm13082440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
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.
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Affiliation(s)
- Beatrice Leonardi
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Antonio Marella
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Francesco Leone
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Francesca Capasso
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Noemi Maria Giorgiano
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Davide Gerardo Pica
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Rosa Mirra
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Gaetana Messina
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Motta
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Eva Aurora Massimilla
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Gaetano Motta
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Valentina Peritone
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Claudio Andreetti
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
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