Surgical therapy and outcome of descending necrotizing mediastinitis in Chinese: a single-center series

Zhewei Zhao; Dongjie Ma; Yuan Xu; Chao Guo; Shanqing Li; Jian Wang; Mu Wang; Yingzhi Qin; Hongsheng Liu

doi:10.3389/fmed.2023.1337852

Surgical therapy and outcome of descending necrotizing mediastinitis in Chinese: a single-center series

Front Med (Lausanne). 2024 Jan 11:10:1337852. doi: 10.3389/fmed.2023.1337852. eCollection 2023.

Authors

Zhewei Zhao¹, Dongjie Ma¹, Yuan Xu¹, Chao Guo¹, Shanqing Li¹, Jian Wang², Mu Wang³, Yingzhi Qin¹, Hongsheng Liu¹

Affiliations

¹ Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of ENT, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Descending Necrotizing Mediastinitis (DNM) is an acute and often fatal infection that affects the neck and mediastinum. DNM treatment consists of broad-spectrum antibiotics, early diagnosis, and surgical debridement with multidisciplinary cooperation. However, owing to the rarity and complexity of this disease, the mortality rate is high. This retrospective study analyzed a single-center experience of managing DNM in Chinese patients over the last 10 years.

Methods: A single-center, retrospective, observational, and descriptive study was conducted on 31 patients with DNM at Peking Union Medical College Hospital from 2012 to 2022. Case report forms were used to collect data which were then analyzed with a focus on surgical management and outcomes.

Results: This study examined the outcomes of 31 patients diagnosed with DNM at our hospital. The most common comorbidities on admission were hypertension (48%) and diabetes mellitus (42%). The degree of diffusion of DNM according to Endo's classification was classified as follows: type I in 7 patients (22.6%), type IIA in 5 (16.1%), and type IIB in 19 patients (61.3%). Among these patients, 13 (41.9%) were found to have a single microbial infection, while 16 (51.6%) were found to have polymicrobial infections. In all cases, neck drainage was performed via cervicotomy, with multiple drains (64.5%) and vacuum sealing drainage (VSD) (35.5%). Mediastinal drainage was performed via a cervical mediastinotomy (51.6%), video-assisted thoracic surgery (VATS) (41.9%), or thoracotomy (6.5%). The 30-day mortality rate was 25.8% and 24.0 days of the average length of hospital stay.

Conclusion: Early accurate diagnosis and timely intervention have been shown to be correlated with a positive prognosis. Cervicothoracic CT (computed tomography) is essential for the diagnosis, staging, and evaluation of the optimal surgical treatment. Cervicotomy and video-assisted thoracoscopic surgery with percutaneous drainage is effective, even in advanced cases. Additionally, the application of VSD in cervical incision did not improve prognosis but may shorten the length of ICU (intensive care unit) and hospital stays.

Keywords: descending necrotizing mediastinitis; surgical treatment; transcervical drainage; transthoracic drainage; video-assisted thoracic surgery.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (No. 82102745), the National High Level Hospital Clinical Research Funding (Nos. 2022-PUMCH-A-187 and 2022-PUMCH-B-012), and the CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2022 I2M C&T B 002).