Descending Necrotizing Anterior Mediastinitis: Analysis of Survival and Surgical Treatment Modalities

Misthos, Panagiotis; Katsaragakis, Stylianos; Kakaris, Stamatis; Theodorou, Dimitrios; Skottis, Ioannis

doi:10.1016/j.joms.2006.06.287

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Volume 65, Issue 4 , Pages 635-639, April 2007

Descending Necrotizing Anterior Mediastinitis: Analysis of Survival and Surgical Treatment Modalities

Panagiotis Misthos, MD
- Staff Surgeon, First Propaedeutic Surgical Department, University of Athens Medical School, Athens, Greece.
- Address correspondence and reprint requests to Dr Misthos: 7 P. Dimitrakopoulou Street, 11141, Athens, Greece
Stylianos Katsaragakis, MD, PhD
- Assistant Professor of Surgery, First Thoracic Surgical Department, SOTIRIA General Hospital for Chest Diseases, Athens, Greece.
Stamatis Kakaris, MD, PhD
- Staff Surgeon, First Thoracic Surgical Department, SOTIRIA General Hospital for Chest Diseases, Athens, Greece.
Dimitrios Theodorou, MD, PhD
- Associate Professor of Surgery, First Propaedeutic Surgical Department, University of Athens Medical School, Athens, Greece.
Ioannis Skottis, MD
- Department Head, First Thoracic Surgical Department, SOTIRIA General Hospital for Chest Diseases, Athens, Greece.

Purpose

Descending necrotizing anterior mediastinitis (DNAM) is a severe infectious disease with a very high mortality rate. The aim of this study was to define the impact of several clinical factors on survival.

Patients and Methods

Between 1985 and 2002, 27 patients were managed for DNAM, 11 with combined transthoracic mediastinal and cervical drainage (group A) and 16 with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage (group B). The records of all patients were statistically analyzed for the impact of several clinical factors on survival.

Results

Although patients in group A were admitted to the hospital faster, treated with antibiotics as outpatients earlier, and operated on much sooner after hospital admission compared with the patients in group B, multivariate analysis revealed that early combined transthoracic mediastinal and cervical debridement and drainage was the only favorable factor for survival in patients DNAM patients (odds ratio = 9.99; 95% confidence interval = 1.02 to 97.49).

Conclusions

Less extensive surgical approaches (ie, thoracic drainage without cervical drainage or combined cervical and subxiphoid thoracic drainage) led to unsatisfactory results and high reoperation rates. In contrast, early, aggressive combined cervical and thoracic drainage proved to be an effective method for managing DNAM.