The timing of chest tube removal after resection of the lung or esophageal cancer: A randomized controlled study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Jinghai , LI Kun , LI Yanning , DENG Bo , WANG Ruwen ,  TAN Qunyou

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P.R.China;

Corresponding author：

TAN Qunyou, Email: 13983770929@163.com

Keywords：

Lung cancer; esophageal cancer; resection; timing of chest tube removal

DOI：

10.7507/1007-4848.201811052

Video：

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Objective To evaluate the timing of chest tube removal after resection of lung or esophageal cancer.Methods A prospective randomized controlled study was performed. From June 2014 to February 2016, 150 patients suspected with the cancer of lung or esophagus undergoing neoplasm resection and lymph node dissection in our single medical unit were classified into 3 groups according to the random number generated by SPSS17.0 with 50 patients in the each group. The drainage volume for chest tube removal was ≤100 mL/d in the group Ⅰ, 101–200 mL/d in the group Ⅱ, and 201–300 mL/d in the group Ⅲ. Chest radiography was performed 48 hours following chest tube removal. Results The 127 patients (108 males and 19 females, with an average age of 59.0±8.7 years) eligible for analysis consisted of 45 patients in the group Ⅰ, 41 in the group Ⅱ, and 41 in the group Ⅲ respectively after the 23 patients were excluded from this study who were diagnosed as benign lesions through intraoperative frozen pathology (n=20) and postoperative complications (empyema in 2 patients and chylothorax in 1 patient). Age, sex, types of neoplasm, and comorbidities except procedures via video-assisted thoracic surgery (and laparoscopy) showed no significant difference among the three groups (P>0.05). No mortality was observed in this study. There were postoperative complications in 6 patients and its distribution had no statistical differences among the three groups (P>0.05). The mean postoperative duration of chest tube was 181.0±68.2 h, 111.0±63.1 h, 76.0±37.2 h, the mean drainage volume was 1 413.0±500.9 mL, 1 005.0±686.4 mL, 776.0±505.8 mL, and the mean hospital stay time following chest tube removal was 19.0±9.7 d, 14.0±8.0 d, 9.0±4.8 d in the group Ⅰ,Ⅱ and Ⅲ, respectively; there was a significant difference among the three groups (P=0.000). The 13 patients required reintervention after chest tube removal due to pleural effusion accumulation and there was no difference among the three groups (P>0.05). Chest pain relieved essentially after chest tube removal in all patients.Conclusion A drainage volume of ≤300 mL/d as a threshold for chest tube removal after resection of lung or esophageal cancer can shorten postoperative hospital stay and accelerate early recovery of the patients.

Citation： ZHOU Jinghai, LI Kun, LI Yanning, DENG Bo, WANG Ruwen, TAN Qunyou. The timing of chest tube removal after resection of the lung or esophageal cancer: A randomized controlled study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(9): 853-857. doi: 10.7507/1007-4848.201811052 Copy

1.	Zhang TX, Zhang Y, Liu ZD, et al. The volume threshold of 300 versus 100 ml/day for chest tube removal after pulmonary lobectomy: a meta-analysis. Interact Cardiovasc Thorac Surg, 2018, 27(5): 695-702.
2.	Gao S, Zhang Z, Aragón J, et al. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis, 2017, 9(9): 3255-3264.
3.	Yao F, Wang J, Yao J, et al. Early chest tube removal after thoracoscopic esophagectomy with high output. J Laparoendosc Adv Surg Tech A, 2016, 26(1): 17-22.
4.	Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg, 2014, 45(2): 241-246.
5.	Olgac G, Cosgun T, Vayvada M, et al. Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy. Interact Cardiovasc Thorac Surg, 2014, 19(4): 650-655.
6.	Nakanishi R, Fujino Y, Kato M, et al. Early chest tube removal after thoracoscopic lobectomy with the aid of an additional thin tube: a prospective multi-institutional study. Gen Thorac Cardiovasc Surg, 2018, 66(12): 723-730.
7.	Younes RN, Gross JL, Aguiar S, et al. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg, 2002, 195(5): 658-662.
8.	Nakanishi R, Fujino Y, Yamashita T, et al. A prospective study of the association between drainage volume within 24 hours after thoracoscopic lobectomy and postoperative morbidity. J Thorac Cardiovasc Surg, 2009, 137(6): 1394-1399.
9.	Brunelli A, Beretta E, Cassivi SD, et al. Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg, 2011, 40(2): 291-297.
10.	Utter GH. The rate of pleural fluid drainage as a criterion for the timing of chest tube removal: theoretical and practical considerations. Ann Thorac Surg, 2013, 96(6): 2262-2267.
11.	Tomlinson MA, Treasure T. Insertion of a chest drain: how to do it. Br J Hosp Med, 1997, 58(6): 248-252.
12.	Zocchi L. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J, 2002, 20(6): 1545-1558.
13.	Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.
14.	Hessami MA, Najafi F, Hatami S. Volume threshold for chest tube removal: a randomized controlled trial. J Inj Violence Res, 2009, 1(1): 33-36.
15.	Xie HY, Xu K, Tang JX, et al. A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg, 2015, 21(2): 200-205.
16.	Zhang Y, Li H, Hu B, et al. A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy. World J Surg, 2014, 38(1): 60-67.
17.	Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg, 2008, 135(2): 269-273.

1. Zhang TX, Zhang Y, Liu ZD, et al. The volume threshold of 300 versus 100 ml/day for chest tube removal after pulmonary lobectomy: a meta-analysis. Interact Cardiovasc Thorac Surg, 2018, 27(5): 695-702.
2. Gao S, Zhang Z, Aragón J, et al. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis, 2017, 9(9): 3255-3264.
3. Yao F, Wang J, Yao J, et al. Early chest tube removal after thoracoscopic esophagectomy with high output. J Laparoendosc Adv Surg Tech A, 2016, 26(1): 17-22.
4. Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg, 2014, 45(2): 241-246.
5. Olgac G, Cosgun T, Vayvada M, et al. Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy. Interact Cardiovasc Thorac Surg, 2014, 19(4): 650-655.
6. Nakanishi R, Fujino Y, Kato M, et al. Early chest tube removal after thoracoscopic lobectomy with the aid of an additional thin tube: a prospective multi-institutional study. Gen Thorac Cardiovasc Surg, 2018, 66(12): 723-730.
7. Younes RN, Gross JL, Aguiar S, et al. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg, 2002, 195(5): 658-662.
8. Nakanishi R, Fujino Y, Yamashita T, et al. A prospective study of the association between drainage volume within 24 hours after thoracoscopic lobectomy and postoperative morbidity. J Thorac Cardiovasc Surg, 2009, 137(6): 1394-1399.
9. Brunelli A, Beretta E, Cassivi SD, et al. Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg, 2011, 40(2): 291-297.
10. Utter GH. The rate of pleural fluid drainage as a criterion for the timing of chest tube removal: theoretical and practical considerations. Ann Thorac Surg, 2013, 96(6): 2262-2267.
11. Tomlinson MA, Treasure T. Insertion of a chest drain: how to do it. Br J Hosp Med, 1997, 58(6): 248-252.
12. Zocchi L. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J, 2002, 20(6): 1545-1558.
13. Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.
14. Hessami MA, Najafi F, Hatami S. Volume threshold for chest tube removal: a randomized controlled trial. J Inj Violence Res, 2009, 1(1): 33-36.
15. Xie HY, Xu K, Tang JX, et al. A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg, 2015, 21(2): 200-205.
16. Zhang Y, Li H, Hu B, et al. A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy. World J Surg, 2014, 38(1): 60-67.
17. Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg, 2008, 135(2): 269-273.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The timing of chest tube removal after resection of the lung or esophageal cancer: A randomized controlled study

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