Thoracic autonomic nervous system surgery current application—a survey among members of the European Society of Thoracic Surgeons
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Thoracic autonomic nervous system surgery is mainly used for hyperhidrosis/facial flushing, whereas cardiac and vascular indications are limited. The literature remains controversial regarding the correct indications and surgical technique, with the lack of homogeneous data being a major limitation. We designed a survey to investigate current practice among members of the European Society of Thoracic Surgeons (ESTS). Methods: A 29-question ad hoc questionnaire was available to all ESTS members from December 2022 to February 2023. It included questions on demographics, indications, preoperative evaluation, technique, complications and follow-up. A descriptive analysis of the data is presented. Results: The response rate was 7% and 121 of 123 valid responses were analysed. Sympathetic surgery was performed for hyperhidrosis/facial flushing, cardiac and vascular disease in 99%, 29% and 29% of respondents respectively. Palmar hyperhidrosis was the most common, followed by axillary, facial flushing and craniofacial hyperhidrosis. Catecholaminergic ventricular tachycardia was more common than long QT syndrome and Raynaud's over Buerger's disease. Data analysis showed that members preferred nerve cutting to clipping (66%, 64% and 58% for hyperhidrosis/facial flushing, cardiac and vascular disease respectively). Preference for the target level of nerve block varied significantly depending on the condition addressed. For most responders (65%), severe compensatory sweating was an adverse event, occurring in less than 10% of treated cases. Only 52% used a database for follow-up. Conclusions: Current practice in sympathetic surgery in ESTS responders is consistent with the available evidence, although it is characterized by great heterogeneity in almost all aspects. A database could help to standardize patient selection, surgical techniques and follow-up, and provide the basis for future multi-institutional trials.
Source: Journal of Thoracic Disease
DOI: 10.21037/jtd-24-1167
Institutions: University of Bologna, University of Szeged, Biruni University, Ruhrlandklinik, Stiftung Universitätsmedizin Essen, University of Duisburg-Essen, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, Strasbourg, Centre Hospitalier de Wallonie Picarde, Medical University of Vienna, Universitair Ziekenhuis Leuven, Hospital de Santa Marta, Hospital Universitario Puerta de Hierro Majadahonda, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408034506