{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:13:56Z","timestamp":1790604836950,"version":"4.1.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>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, \u22120.0077 with 95% confidence interval of \u22120.0959 to 0.0805 (P\u2009=\u20090.8649). 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The outcome of DNM treatment does not depend on thoracotomy or VATS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivad053","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T17:05:08Z","timestamp":1680714308000},"source":"Crossref","is-referenced-by-count":8,"title":["The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis"],"prefix":"10.1093","volume":"36","author":[{"given":"Yugo","family":"Tanaka","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, Kobe University Graduate School of Medicine , Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5315-9718","authenticated-orcid":false,"given":"Yoshimasa","family":"Maniwa","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Kobe University Graduate School of Medicine , Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Sugio","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Breast Surgery, Oita University , Oita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuro","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center , Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken-Ichi","family":"Nibu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine , Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Omori","sequence":"additional","affiliation":[{"name":"Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University , Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Jichi Medical University , Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kuwano","sequence":"additional","affiliation":[{"name":"Fukuoka City Hospital , Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8502-1502","authenticated-orcid":false,"given":"Masayuki","family":"Chida","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Dokkyo Medical University School of Medicine , Shimotsuga, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Toh","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kyushu Cancer Center , Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0601-3828","authenticated-orcid":false,"given":"Morihito","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Hiroshima University , Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Shiotani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Defense Medical College , Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Chiba University Graduate School of Medicine , Chiba, 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