Thoracic drainage with traditional chest tube versus central venous catheter after video-assisted thoracoscopic lobectomy: A randomized controlled study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Weiqiang ¹ , JIANG Jie ¹ , ZHAO Guang ¹ , YU Xiuyi ¹ , MI Yanjun ² , ZHU Xiaolei ¹ , LI Ning ¹ , LIU Hongming ¹ ,  GENG Guojun ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, P. R. China;
2. Department of Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

GENG Guojun, Email: ggj622@126.com

Keywords：

Chest tube; central venous catheter; video-assisted thoracoscopic lobectomy; lung cancer; randomized controlled study

DOI：

10.7507/1007-4848.202101062

Video：

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Objective To evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube.Methods This study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups.Results Finally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL,P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000].Conclusion Compared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.

Citation： CHEN Weiqiang, JIANG Jie, ZHAO Guang, YU Xiuyi, MI Yanjun, ZHU Xiaolei, LI Ning, LIU Hongming, GENG Guojun. Thoracic drainage with traditional chest tube versus central venous catheter after video-assisted thoracoscopic lobectomy: A randomized controlled study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1618-1624. doi: 10.7507/1007-4848.202101062 Copy

1.	De la Gala F, Piñeiro P, Reyes A, et al. Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial. Trials, 2019, 20(1): 622.
2.	Triphuridet N, Henschke C. Landscape on CT screening for lung cancer in Asia. Lung Cancer (Auckl), 2019, 10: 107-124.
3.	Mei J, Guo C, Xia L, et al. Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage Ⅰ-Ⅱ non-small cell lung cancer are more favorable than thoracotomy: A propensity score-matched analysis from a high-volume center in China. Transl Lung Cancer Res, 2019, 8(2): 155-166.
4.	Nwogu CE, D'Cunha J, Pang H, et al. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg, 2015, 99(2): 399-405.
5.	Yan S, Wang X, Wang Y, et al. Intermittent chest tube clamping may shorten chest tube drainage and postoperative hospital stay after lung cancer surgery: A propensity score matching analysis. J Thorac Dis, 2017, 9(12): 5061-5067.
6.	Porcel JM. Chest tube drainage of the pleural space: A concise review for pulmonologists. Tuberc Respir Dis (Seoul), 2018, 81(2): 106-115.
7.	Venuta F, Diso D, Anile M, et al. Chest tubes: Generalities. Thorac Surg Clin, 2017, 27(1): 1-5.
8.	Miller KS, Sahn SA. Chest tubes. Indications, technique, management and complications. Chest, 1987, 91(2): 258-264.
9.	Baringer K, Talbert S. Chest drainage systems and management of air leaks after a pulmonary resection. J Thorac Dis, 2017, 9(12): 5399-5403.
10.	Benton IJ, Benfield GF. Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces. Respir Med, 2009, 103(10): 1436-1440.
11.	Lee JH, Kim R, Park CM. Chest tube drainage versus conservative management as the initial treatment of primary spontaneous pneumothorax: A systematic review and meta-analysis. J Clin Med, 2020, 9(11): 3456.
12.	Pathak V, Allender JE, Grant MW. Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures. Eur Respir Rev, 2017, 26(145): 170020.
13.	Prokakis C, Koletsis EN, Apostolakis E, et al. Routine suction of intercostal drains is not necessary after lobectomy: A prospective randomized trial. World J Surg, 2008, 32(11): 2336-2342.
14.	中华医学会, 中华医学会肿瘤学分会. 中华医学会肺癌临床诊疗指南(2018版). 中华肿瘤杂志, 2018, 40(12): 935-964.
15.	于修义, 姜杰, 耿国军, 等. 3D电视胸腔镜肺占位病变切除术. 2014, 14(4): 359-361.
16.	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.
17.	French DG, Dilena M, LaPlante S, et al. Optimizing postoperative care protocols in thoracic surgery: Best evidence and new technology. J Thorac Dis, 2016, 8(Suppl 1): S3-S11.
18.	Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials. Anesth Analg, 1998, 86(3): 598-612.
19.	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.
20.	Okur E, Baysungur V, Tezel C, et al. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg, 2009, 35(1): 32-35.
21.	Birath G, Swenson EW. Resistance to air flow in bronchospirometric catheters. J Thorac Surg, 1957, 33(2): 275-281.
22.	Baumann MH, Strange C. Treatment of spontaneous pneumothorax: A more aggressive approach? Chest, 1997, 112(3): 789-804.
23.	DeLoach LJ, Higgins MS, Caplan AB, et al. The visual analog scale in the immediate postoperative period: Intrasubject variability and correlation with a numeric scale. Anesth Analg, 1998, 86(1): 102-106.
24.	Baumann MH. What size chest tube? What drainage system is ideal? And other chest tube management questions. Curr Opin Pulm Med, 2003, 9(4): 276-281.
25.	Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax, 2005, 60 Suppl 1(Suppl 1): i1-i21.

1. De la Gala F, Piñeiro P, Reyes A, et al. Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial. Trials, 2019, 20(1): 622.
2. Triphuridet N, Henschke C. Landscape on CT screening for lung cancer in Asia. Lung Cancer (Auckl), 2019, 10: 107-124.
3. Mei J, Guo C, Xia L, et al. Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage Ⅰ-Ⅱ non-small cell lung cancer are more favorable than thoracotomy: A propensity score-matched analysis from a high-volume center in China. Transl Lung Cancer Res, 2019, 8(2): 155-166.
4. Nwogu CE, D'Cunha J, Pang H, et al. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg, 2015, 99(2): 399-405.
5. Yan S, Wang X, Wang Y, et al. Intermittent chest tube clamping may shorten chest tube drainage and postoperative hospital stay after lung cancer surgery: A propensity score matching analysis. J Thorac Dis, 2017, 9(12): 5061-5067.
6. Porcel JM. Chest tube drainage of the pleural space: A concise review for pulmonologists. Tuberc Respir Dis (Seoul), 2018, 81(2): 106-115.
7. Venuta F, Diso D, Anile M, et al. Chest tubes: Generalities. Thorac Surg Clin, 2017, 27(1): 1-5.
8. Miller KS, Sahn SA. Chest tubes. Indications, technique, management and complications. Chest, 1987, 91(2): 258-264.
9. Baringer K, Talbert S. Chest drainage systems and management of air leaks after a pulmonary resection. J Thorac Dis, 2017, 9(12): 5399-5403.
10. Benton IJ, Benfield GF. Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces. Respir Med, 2009, 103(10): 1436-1440.
11. Lee JH, Kim R, Park CM. Chest tube drainage versus conservative management as the initial treatment of primary spontaneous pneumothorax: A systematic review and meta-analysis. J Clin Med, 2020, 9(11): 3456.
12. Pathak V, Allender JE, Grant MW. Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures. Eur Respir Rev, 2017, 26(145): 170020.
13. Prokakis C, Koletsis EN, Apostolakis E, et al. Routine suction of intercostal drains is not necessary after lobectomy: A prospective randomized trial. World J Surg, 2008, 32(11): 2336-2342.
14. 中华医学会, 中华医学会肿瘤学分会. 中华医学会肺癌临床诊疗指南(2018版). 中华肿瘤杂志, 2018, 40(12): 935-964.
15. 于修义, 姜杰, 耿国军, 等. 3D电视胸腔镜肺占位病变切除术. 2014, 14(4): 359-361.
16. 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.
17. French DG, Dilena M, LaPlante S, et al. Optimizing postoperative care protocols in thoracic surgery: Best evidence and new technology. J Thorac Dis, 2016, 8(Suppl 1): S3-S11.
18. Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials. Anesth Analg, 1998, 86(3): 598-612.
19. 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.
20. Okur E, Baysungur V, Tezel C, et al. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg, 2009, 35(1): 32-35.
21. Birath G, Swenson EW. Resistance to air flow in bronchospirometric catheters. J Thorac Surg, 1957, 33(2): 275-281.
22. Baumann MH, Strange C. Treatment of spontaneous pneumothorax: A more aggressive approach? Chest, 1997, 112(3): 789-804.
23. DeLoach LJ, Higgins MS, Caplan AB, et al. The visual analog scale in the immediate postoperative period: Intrasubject variability and correlation with a numeric scale. Anesth Analg, 1998, 86(1): 102-106.
24. Baumann MH. What size chest tube? What drainage system is ideal? And other chest tube management questions. Curr Opin Pulm Med, 2003, 9(4): 276-281.
25. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax, 2005, 60 Suppl 1(Suppl 1): i1-i21.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Thoracic drainage with traditional chest tube versus central venous catheter after video-assisted thoracoscopic lobectomy: A randomized controlled study

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