Early chest tube removal following single-direction versus conventional uniportal video-assisted thoracoscopic lobectomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Weigang ^1,2 ,  ZHANG Hao ¹ , WU Wenbin ² , ZHAO Tian ¹ , ZHANG Miao ² , ZHANG Hui ²

1. Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, P. R. China;
2. Department of Cardiothoracic Surgery, Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P. R. China;

Corresponding author：

ZHANG Hao, Email: haozhang_xz@163.com

Keywords：

Early chest tube removal; single-direction; uniportal video-assisted thoracoscopic surgery; lobectomy

DOI：

10.7507/1007-4848.202204029

Video：

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Objective To explore the feasibility of early chest tube removal following single-direction uniportal video-assisted thoracoscopic surgery (S-UVATS) anatomical lobectomy. Methods The clinical data of consecutive VATS lobectomy by different surgeons in Xuzhou Central Hospital between May 2019 and February 2022 were retrospectively reviewed. Finally, the data of 1 084 patients were selected for analysis, including 538 males and 546 females, with a mean age of 61.0±10.1 years. These patients were divided into a S-UVATS group with 558 patients and a conventional group (C-UVATS) with 526 patients according to the surgical procedures. The perioperative parameters such as operation time, blood loss were recorded. In addition, we assessed the amount of residual pleural effusion and the probability of secondary thoracentesis when taking 300 mL/d and 450 mL/d as the threshold of chest tube removal. Results Tumor-negative surgical margin was achieved without mortality in this cohort. As compared with the C-UVATS group, patients in the S- UVATS group demonstrated significantly shorter operation time (P<0.001), less blood loss (P=0.002), lower rate of conversion to multiple-port VATS or thoracotomy (P=0.003), but more stations and numbers of dissected lymph nodes as well as less suture staplers (P<0.001). Moreover, patients in the S-UVATS demonstrated shorter chest tube duration, less total volume of thoracic drainage and shorter postoperative hospital stay, with statistical differences (P<0.001). After excluding patients of chylothorax and prolonged air leaks>7 d, subgroup analysis was performed. First, assuming that 300 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, patients in the S-UVATS group would report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Second, assuming that 450 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, the S-UVATS group would also report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Further multivariable logistic regression analysis indicated that S-UVATS was significantly negatively related to drainage volume>1 000 mL (P<0.05); whereas combined lobectomy, longer operation time, more blood loss and air leakage were independent risk factors correlated with drainage volume>1 000 mL following UVATS lobectomy (P<0.05). Conclusion The short-term efficacy of S-UVATS lobectomy is significantly better than that of the conventional group, indicating shorter operation time and less chest drainage. However, early chest tube removal with a high threshold of thoracic drainage volume probably increases the risk of secondary thoracentesis due to residual pleural effusion.

Citation： CHEN Weigang, ZHANG Hao, WU Wenbin, ZHAO Tian, ZHANG Miao, ZHANG Hui. Early chest tube removal following single-direction versus conventional uniportal video-assisted thoracoscopic lobectomy: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 71-77. doi: 10.7507/1007-4848.202204029 Copy

1.	Xing T, Li X, Liu J, et al. Early removal of chest tubes leads to better short-term outcome after video-assisted thoracoscopic surgery lung resection. Ann Transl Med, 2020, 8(4): 101.
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.	谢冬, 陈昶, 朱余明, 等. 日间手术及加速康复外科用于早期肺癌微创外科517例的探索与实践. 中国胸心血管外科临床杂志, 2022.
4.	Yap KH, Soon JL, Ong BH, et al. The safe volume threshold for chest drain removal following pulmonary resection. Interact Cardiovasc Thorac Surg, 2017, 25(5): 822-826.
5.	Huang L, Kehlet H, Holbek BL, et al. Efficacy and safety of omitting chest drains after video-assisted thoracoscopic surgery: A systematic review and meta-analysis. J Thorac Dis, 2021, 13(2): 1130-1142.
6.	周健, 蒲强, 梅建东, 等. 单孔与三孔胸腔镜肺叶切除术治疗肺癌2112例围术期效果的比较: 一项倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2021, 28(9): 1005-1011.
7.	刘成武, 郭成林, 林锋, 等. 单向式胸腔镜肺叶或肺段切除术治疗Ⅰ期肺癌的远期疗效. 中华外科杂志, 2015, 53(10): 742-746.
8.	赵田, 张淼, 武文斌, 等. 单向式理念在单孔胸腔镜肺叶切除术中的应用. 中华腔镜外科杂志(电子版), 2018, 11(5): 295-299.
9.	刘伦旭, 王天佑, 张逊, 等. 围手术期雾化吸入异丙托溴铵治疗胸外科手术合并COPD患者的随机、双盲、安慰剂对照、平行、多中心研究. 中国胸心血管外科临床杂志, 2022, 29(4): 417-423.
10.	孙大强, 陈平雁, 刘伦旭, 等. 11958例Ⅰ~ⅢA期非小细胞肺癌手术患者不同随访方式5年生存率比较的多中心真实世界研究. 中国胸心血管外科临床杂志, 2021, 28(6): 615-622.
11.	刘伦旭, 刘雪梅. 用质量控制和技术规范改善胸心血管外科临床结果—2018新春寄语. 中国胸心血管外科临床杂志, 2018, 25(2): 103-104.
12.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
13.	Motono N, Iwai S, Funasaki A, et al. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond), 2019, 43: 29-32.
14.	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.
15.	Dong Y, Li J, Chang J, et al. Video-assisted thoracoscopic day surgery for patients with pulmonary nodules: A single-center clinical experience of 200 cases. Cancer Manag Res, 2021, 13: 6169-6179.
16.	Ueda K, Haruki T, Murakami J, et al. No drain after thoracoscopic major lung resection for cancer helps preserve the physical function. Ann Thorac Surg, 2019, 108(2): 399-404.
17.	Yong LS, Lin MW, Chen KC, et al. Drainless thoracoscopic lobectomy for lung cancer. J Clin Med, 2021, 10(16): 3679.
18.	Mendogni P, Tosi D, Marulli G, et al. Multicenter randomized controlled trial comparing digital and traditional chest drain in a VATS pulmonary lobectomy cohort: Interim analysis. J Cardiothorac Surg, 2021, 16(1): 188.
19.	Zhou J, Li C, Zheng Q, et al. Suction versus nonsuction drainage after uniportal video-assisted thoracoscopic surgery: A propensity score-matched study. Front Oncol, 2021, 11: 751396.
20.	Wang Y, Pei Y, Lv C, et al. Intermittent chest tube clamping decreases chest tube duration time and drainage volume after lung cancer surgery in patients without air leak: An open-label, randomized controlled trial. Transl Lung Cancer Res, 2022, 11(3): 357-365.
21.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南 (2022版). 中华医学杂志, 2022, 102(23): 1706-1740.
22.	刘成武, 梅建东, 刘伦旭. 中国胸腔镜肺叶切除临床实践指南. 中华医学杂志, 2018, 98(47): 3832-3841.
23.	Guo C, Xia L, Mei J, et al. A propensity score matching study of non-grasping en bloc mediastinal lymph node dissection versus traditional grasping mediastinal lymph node dissection for non-small cell lung cancer by video-assisted thoracic surgery. Transl Lung Cancer Res, 2019, 8(2): 176-186.

1. Xing T, Li X, Liu J, et al. Early removal of chest tubes leads to better short-term outcome after video-assisted thoracoscopic surgery lung resection. Ann Transl Med, 2020, 8(4): 101.
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. 谢冬, 陈昶, 朱余明, 等. 日间手术及加速康复外科用于早期肺癌微创外科517例的探索与实践. 中国胸心血管外科临床杂志, 2022.
4. Yap KH, Soon JL, Ong BH, et al. The safe volume threshold for chest drain removal following pulmonary resection. Interact Cardiovasc Thorac Surg, 2017, 25(5): 822-826.
5. Huang L, Kehlet H, Holbek BL, et al. Efficacy and safety of omitting chest drains after video-assisted thoracoscopic surgery: A systematic review and meta-analysis. J Thorac Dis, 2021, 13(2): 1130-1142.
6. 周健, 蒲强, 梅建东, 等. 单孔与三孔胸腔镜肺叶切除术治疗肺癌2112例围术期效果的比较: 一项倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2021, 28(9): 1005-1011.
7. 刘成武, 郭成林, 林锋, 等. 单向式胸腔镜肺叶或肺段切除术治疗Ⅰ期肺癌的远期疗效. 中华外科杂志, 2015, 53(10): 742-746.
8. 赵田, 张淼, 武文斌, 等. 单向式理念在单孔胸腔镜肺叶切除术中的应用. 中华腔镜外科杂志(电子版), 2018, 11(5): 295-299.
9. 刘伦旭, 王天佑, 张逊, 等. 围手术期雾化吸入异丙托溴铵治疗胸外科手术合并COPD患者的随机、双盲、安慰剂对照、平行、多中心研究. 中国胸心血管外科临床杂志, 2022, 29(4): 417-423.
10. 孙大强, 陈平雁, 刘伦旭, 等. 11958例Ⅰ~ⅢA期非小细胞肺癌手术患者不同随访方式5年生存率比较的多中心真实世界研究. 中国胸心血管外科临床杂志, 2021, 28(6): 615-622.
11. 刘伦旭, 刘雪梅. 用质量控制和技术规范改善胸心血管外科临床结果—2018新春寄语. 中国胸心血管外科临床杂志, 2018, 25(2): 103-104.
12. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
13. Motono N, Iwai S, Funasaki A, et al. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond), 2019, 43: 29-32.
14. 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.
15. Dong Y, Li J, Chang J, et al. Video-assisted thoracoscopic day surgery for patients with pulmonary nodules: A single-center clinical experience of 200 cases. Cancer Manag Res, 2021, 13: 6169-6179.
16. Ueda K, Haruki T, Murakami J, et al. No drain after thoracoscopic major lung resection for cancer helps preserve the physical function. Ann Thorac Surg, 2019, 108(2): 399-404.
17. Yong LS, Lin MW, Chen KC, et al. Drainless thoracoscopic lobectomy for lung cancer. J Clin Med, 2021, 10(16): 3679.
18. Mendogni P, Tosi D, Marulli G, et al. Multicenter randomized controlled trial comparing digital and traditional chest drain in a VATS pulmonary lobectomy cohort: Interim analysis. J Cardiothorac Surg, 2021, 16(1): 188.
19. Zhou J, Li C, Zheng Q, et al. Suction versus nonsuction drainage after uniportal video-assisted thoracoscopic surgery: A propensity score-matched study. Front Oncol, 2021, 11: 751396.
20. Wang Y, Pei Y, Lv C, et al. Intermittent chest tube clamping decreases chest tube duration time and drainage volume after lung cancer surgery in patients without air leak: An open-label, randomized controlled trial. Transl Lung Cancer Res, 2022, 11(3): 357-365.
21. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南 (2022版). 中华医学杂志, 2022, 102(23): 1706-1740.
22. 刘成武, 梅建东, 刘伦旭. 中国胸腔镜肺叶切除临床实践指南. 中华医学杂志, 2018, 98(47): 3832-3841.
23. Guo C, Xia L, Mei J, et al. A propensity score matching study of non-grasping en bloc mediastinal lymph node dissection versus traditional grasping mediastinal lymph node dissection for non-small cell lung cancer by video-assisted thoracic surgery. Transl Lung Cancer Res, 2019, 8(2): 176-186.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early chest tube removal following single-direction versus conventional uniportal video-assisted thoracoscopic lobectomy: A retrospective cohort study

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