1
|
Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
| |
Collapse
|
2
|
Song L, Chen X, Zhu L, Qian G, Xu Y, Song Z, Li J, Chen T, Huang J, Luo Q, Cheng X, Yang Y. Perioperative outcomes of bi-pigtail catheter drainage strategy versus conventional chest tube after uniportal video-assisted thoracic lung surgery. Eur J Cardiothorac Surg 2023; 64:ezad411. [PMID: 38078822 DOI: 10.1093/ejcts/ezad411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Chest tube (CT) drainage is a main cause of postoperative pain in lung surgery. Here, we introduced a novel drainage strategy with bi-pigtail catheters (PCs) and conducted a randomized controlled trial to compare with conventional CT drainage after uniportal video-assisted thoracic surgery lung surgery. METHODS A single-centre, prospective, open-labelled, randomized controlled trial (ChiCTR2000035337) was conducted with a preplanned sample size of 396. The primary outcome was the numerical pain rating scale (NPRS) on the first postoperative day. Secondary outcomes included other indicators of postoperative pain, drainage volume, duration of drainage, postoperative hospital stay, incidence of postoperative complications, CT reinsertion and medical costs. RESULTS A total number of 396 patients were randomized between August 2020 and January 2021, 387 of whom were included in the final analysis. The baseline and clinical characteristics of the patients were well balanced between 2 groups. The NPRS on the first postoperative day was significantly lower in the PC group than in the CT group (2.40 ± 1.27 vs 3.02 ± 1.39, p < 0.001), as well as the second/third-day NPRS, the incidence of sudden severe pain (9/192, 4.7% vs 34/195, 17.4%, P < 0.001) and pain requiring intervention (19/192, 9.9% vs 46/195, 23.6%, P < 0.001). In addition, the medical cost in the PC group was lower (US$7809 ± 1646 vs US$8205 ± 1815, P = 0.025). Univariable and multivariable analyses revealed that the drainage strategy was the only factor influencing the incidence of pain requiring intervention. CONCLUSIONS The drainage strategy with bi-PCs in patients undergoing uniportal video-assisted thoracic surgery lung surgery alleviates postoperative pain with adequate safety and efficacy.
Collapse
Affiliation(s)
- Liwei Song
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xingshi Chen
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Gang Qian
- Department of Thoracic Surgery, Zhangjiagang Third People's Hospital, Suzhou, China
| | - Yanhui Xu
- Department of Thoracic Surgery, Zhejiang Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Zuodong Song
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiantao Li
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianxiang Chen
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Huang
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qingquan Luo
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinghua Cheng
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunhai Yang
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Bassi M, Mottola E, Mantovani S, Amore D, Pagini A, Diso D, Vannucci J, Poggi C, De Giacomo T, Rendina EA, Venuta F, Anile M. Coaxial Drainage versus Standard Chest Tube after Pulmonary Lobectomy: A Randomized Controlled Study. Curr Oncol 2022; 29:4455-4463. [PMID: 35877214 PMCID: PMC9317584 DOI: 10.3390/curroncol29070354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Chest tubes are routinely inserted after thoracic surgery procedures in different sizes and numbers. The aim of this study is to assess the efficacy of Smart Drain Coaxial drainage compared with two standard chest tubes in patients undergoing thoracotomy for pulmonary lobectomy. Ninety-eight patients (57 males and 41 females, mean age 68.3 ± 7.4 years) with lung cancer undergoing open pulmonary lobectomy were randomized in two groups: 50 received one upper 28-Fr and one lower 32-Fr standard chest tube (ST group) and 48 received one 28-Fr Smart Drain Coaxial tube (SDC group). Hospitalization, quantity of fluid output, air leaks, radiograph findings, pain control and costs were assessed. SDC group showed shorter hospitalization (7.3 vs. 6.1 days, p = 0.02), lower pain in postoperative day-1 (p = 0.02) and a lower use of analgesic drugs (p = 0.04). Pleural effusion drainage was lower in SDC group in the first postoperative day (median 400.0 ± 200.0 mL vs. 450.0 ± 193.8 mL, p = 0.04) and as a mean of first three PODs (median 325.0 ± 137.5 mL vs. 362.5 ± 96.7 mL, p = 0.01). No difference in terms of fluid retention, residual pleural space, subcutaneous emphysema and complications after chest tubes removal was found. In conclusion, Smart Drain Coaxial chest tube seems a feasible option after thoracotomy for pulmonary lobectomy. The SDC group showed a shorter hospitalization and decreased analgesic drugs use and, thus, a reduction of costs.
Collapse
Affiliation(s)
- Massimiliano Bassi
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
- Correspondence: ; Tel./Fax: +39-06-49970220
| | - Emilia Mottola
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Sara Mantovani
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Davide Amore
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Andreina Pagini
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Daniele Diso
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Jacopo Vannucci
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Camilla Poggi
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Tiziano De Giacomo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant’Andrea Hospital, Università La Sapienza, 00189 Rome, Italy;
| | - Federico Venuta
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| | - Marco Anile
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant “PARIDE STEFANINI”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (E.M.); (S.M.); (D.A.); (A.P.); (D.D.); (J.V.); (C.P.); (T.D.G.); (F.V.); (M.A.)
| |
Collapse
|
4
|
Nguyen YL, Maiolino E, De Pauw V, Prieto M, Mazzella A, Peretout JB, Dechartres A, Baillard C, Bobbio A, Daffré E, Alifano M. Enhanced Recovery Pathway in Lung Resection Surgery: Program Establishment and Results of a Cohort Study Encompassing 1243 Consecutive Patients. Cancers (Basel) 2022; 14:cancers14071745. [PMID: 35406517 PMCID: PMC8997103 DOI: 10.3390/cancers14071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Enhanced Recovery Pathways (ERP) have been scarcely assessed in lung cancer surgery. We performed a two-step audit for our experience: the first dealing with our initial experience focusing on patients undergoing segmentectomies and lobectomies, the second including all subsequent consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components were associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting. In total, 166 patients were included in the first period. No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2. The 1-, 3- and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included; 11 patients died during the postoperative period. The overall postoperative adverse event rate was 30.3%. Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones). We conclude that compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events. Abstract Introduction: In spite of increasing diffusion, Enhanced Recovery Pathways (ERP) have been scarcely assessed in large scale programs of lung cancer surgery. The aim of this study was auditing our practice. Methods: A two-step audit program was established: the first dealing with our initial ERP experience in patients undergoing non-extended anatomical segmentectomies and lobectomies, the second including all consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components are associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting. Results: Over a one-year period, 166 patients were included. The median number of ERP procedures per patient was three (IQR 3–4). No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2 (OR = 0.21, 95% CI (0.10–0.46)). The 1-, 3-, and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included in our ERP; 11 patients died during the postoperative period or within 30 days of operation (1.02%). The overall postoperative adverse event rate was 30.3%, major complication occurring in 134 (12.4%), and minor ones in 192 (17.8%). Respiratory complications occurred in 64 (5.9%). Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones). Conclusions: Compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. In a large setting scale, ERP can be applied with satisfactory results in terms of mortality and morbidity. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events.
Collapse
Affiliation(s)
- Yen-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (Y.-L.N.); (J.-B.P.); (C.B.)
| | - Elena Maiolino
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Vincent De Pauw
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Mathilde Prieto
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Antonio Mazzella
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Jean-Baptiste Peretout
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (Y.-L.N.); (J.-B.P.); (C.B.)
| | - Agnès Dechartres
- Département Biostatistique Santé Publique et Information Médicale, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, 75013 Paris, France;
| | - Christophe Baillard
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (Y.-L.N.); (J.-B.P.); (C.B.)
| | - Antonio Bobbio
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Elisa Daffré
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Marco Alifano
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
- Correspondence: ; Tel.: +33-628-336-324
| |
Collapse
|
5
|
Govindraj R, McPherson I, Hawkins R, McLellan M, Hannah A, Asif M, Kirk AJ. Is there an ideal position and size of chest drain following anatomical lung resection? Surgeon 2021; 20:321-327. [PMID: 34600827 DOI: 10.1016/j.surge.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chest drains are placed after surgery to enable lung re-expansion. However, there remains little guidance on optimal placement. This study aims to identify the ideal size and position for chest drain insertion with regards to post-operative outcomes. METHODS 383 patients undergoing lobectomy in 1-year had their chest drain size and x-ray position noted (1 (apical), 2 (mid-zone) or 3 (basal)). Primary outcome was residual air space on immediate post-operative x-ray. Secondary outcomes were length of drain in situ (<72 versus ≥72 h), persisting pleural effusion, surgical emphysema, post-operative pneumonia (POP), and length of hospital stay (<5 versus ≥5 days). Fisher's exact analysis for the primary outcome and binary logistic regression analysis for all outcomes were used. Results presented as odds ratios (OR±95%CI). RESULTS Univariate analysis for residual air space showed increased risk in area 2 (OR = 1.61, p = 0.041) and 3 (OR = 2.59, p = 0.0043) compared with area 1. Multivariate analysis for residual air space showed increased risk in area 2 (OR = 2.39, p < 0.001) and 3 (OR = 2.86, p < 0.001) compared with area 1. Drain size had no impact on residual air space in univariate or multivariate analysis. Multivariate analysis showed area 2 drains remained in situ for >72 h (OR = 1.49, p = 0.017), had persisting effusions (OR = 2.03, p = 0.004) and POP (OR = 2.10, p = 0.023) compared with area 1. This risk is magnified further for drains in area 3. Drains ≥28F had reduced risk of surgical emphysema (OR = 0.23, p = 0.027) in multivariate analysis. CONCLUSION A ≥28F, apical chest drain reduces the risk of post-operative complications, allowing early removal and discharge.
Collapse
Affiliation(s)
- Rohith Govindraj
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Iain McPherson
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK.
| | - Rosalyn Hawkins
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Morag McLellan
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Alexander Hannah
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Mohammed Asif
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Alan Jb Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| |
Collapse
|
6
|
Wang Z, Lv J, Zhang S, Chen W, Wu B, Xue L. Clinical application of a multi-groove silicone drain combined with unidirectional negative-pressure drainage system in single-operating-port video-assisted thoracoscopic lung cancer surgery: a comparison study. J Int Med Res 2021; 49:300060521999766. [PMID: 33909981 PMCID: PMC8108081 DOI: 10.1177/0300060521999766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective To evaluate the effect of a new negative-pressure drainage system in thoracoscopic lung cancer surgery; thereby, providing a new option for postoperative drainage. Methods We retrospectively analyzed data for 200 patients who underwent thoracoscopic surgery between May 2018 and October 2019. According to the thoracic drainage method, the patients were divided into the thoracic tube group and the new system group. The epidemiological and clinicopathological data were compared before operation, and the clinical effect of thoracic drainage was compared after operation. Results There was no significant difference in epidemiological and clinicopathological data between the two groups. There was also no significant difference in drain removal time, hospital stay, and complication rates between the two groups. However, the incidences of pleural effusion and poor incision healing in the new system group were lower than in the thoracic tube group. Visual analog scale (VAS) scores in the new system group were lower than those in the thoracic tube group at each postoperative interval; therefore, the new system group required less analgesia. Conclusion The new system was not inferior to thoracic tubes regarding the drainage effect after thoracoscopic lung cancer surgery. Hence, the system is an alternative to traditional thoracic tubes.
Collapse
Affiliation(s)
- Ze Wang
- Department of Thoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Jian Lv
- Department of Thoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Si'ang Zhang
- Department of Thoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Wenjie Chen
- Department of Thoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Bin Wu
- Department of Thoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Lei Xue
- Department of Thoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| |
Collapse
|
7
|
You J, Zhang H, Li W, Dai N, Zheng Z. Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:175. [PMID: 32690055 PMCID: PMC7372892 DOI: 10.1186/s12957-020-01945-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background Previous randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy. Methods PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. Results A total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = − 0.54, 95%CI (− 0.87, − 0.21)), the duration of drainage (MD = − 0.65, 95%CI (− 1.04, − 0.26)), and the length of hospital stay (MD = − 0.55, 95%CI (− 0.80, − 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups. Conclusions SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.
Collapse
Affiliation(s)
- Jinzhi You
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Hailing Zhang
- The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Wei Li
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Ninghuang Dai
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Zhongfeng Zheng
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China.
| |
Collapse
|
8
|
Wang Q, Ping W, Cai Y, Fu S, Fu X, Zhang N. Modified McKeown procedure with uniportal thoracoscope for upper or middle esophageal cancer: initial experience and preliminary results. J Thorac Dis 2019; 11:4501-4506. [PMID: 31903238 DOI: 10.21037/jtd.2019.11.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Uniportal video-assisted thoracic surgery (VATS) resections are of increasing interest in many thoracic surgery departments. With each experience in VATS lobectomy, we have incrementally improved the less invasive techniques in esophagectomy. Here, we report the preliminary results and feasibility of a modified McKeown procedure with uniportal thoracoscopy for upper or middle esophageal cancer in our institution. Methods Between March 2015 and May 2016, modified uniportal McKeown procedure with uniportal thoracoscopy for upper or middle esophageal cancer was attempted in 44 patients in our institution. Results Of the patients treated with uniportal thoracoscopy and laparoscopy, no patients were converted to open procedures, and all had a complete resection. The mean operative time was 408±34 min (range, 394-495 min). The mean thoracic operation was 163±16 min (range, 135-199 min). The mean blood loss was 245±102 mL (range, 100-450 mL). The mean number of lymph nodes resected was 24 (range, 14-36). The mean ventilator usage of the patients after surgery was 0.3±0.6 days, and the mean intensive care stay was 1.6 days (range, 1 to 7 days). The mean hospital stay was 11.8 days (range, 7 to 22 days). Major complications developed in 2 patients, both of whom had to undergo tracheotomy due to respiratory failure. No patients died of complications postoperatively, and none had clinically significant anastomotic leaks. Conclusions Modified McKeown minimally invasive esophagectomy (MIE) with uniportal thoracoscopy seems to be a feasible option for patients with upper or middle esophageal cancer. Larger studies with longer follow-up are needed to further investigate this approach.
Collapse
Affiliation(s)
- Qi Wang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Ping
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yixin Cai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shengling Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| |
Collapse
|
9
|
Cui Z, Zhang Y, Xu C, Ding C, Chen J, Li C, Zhao J. Comparison of the results of two chest tube managements during an enhanced recovery program after video-assisted thoracoscopic lobectomy: A randomized trial. Thorac Cancer 2019; 10:1993-1999. [PMID: 31475791 PMCID: PMC6775025 DOI: 10.1111/1759-7714.13183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study compared the results of the application of two different chest tube management systems; a drainage ball with low negative pressure and the more commonly used chest tube with water-sealed bottle, after video-assisted thoracoscopic (VATS) lobectomy. METHODS A total of 60 patients undergoing lobectomy were enrolled into this prospective open label randomized clinical trial and equally divided into two groups. The data collected in the trial included age, gender, forced expiratory volume in 1 second (FEV1), blood loss, operation time, drainage volume, drainage time, length of stay, postoperative pain score according to the Visual Analogue Scale (VAS) within 24 hours after surgery and chest tube removal. This study was registered at ClinicalTrials.gov (NCT03598296). RESULTS The characteristics of the patients were similar in both groups. Group ball patients had a lower pain score (after operation: 3.47 ± 1.80 vs. 6.20 ± 1.56, P < 0.001; after removal of chest tube: 1.47 ± 1.28 vs. 3.00 ± 1.29, P < 0.001); less analgesic used (2.83 ± 2.09 times vs. 5.00 ± 3.24 times, P = 0.003); less drainage time (upper tube: 3.89 ± 1.63 days vs. 5.10 ± 2.02 days, P = 0.048; lower tube: upper lobe 4.84 ± 1.61 days vs. 5.90 ± 1.52 days, P = 0.041; lower lobe: 3.82 ± 1.08 days vs. 5.70 ± 2.63 days, P = 0.042) and shorter length of stay (5.40 ± 1.65 days vs. 6.37 ± 1.99 days, P = 0.045). All other related parameters were similar in both groups. CONCLUSIONS For patients undergoing lobectomy, using a drainage ball with negative pressure could reduce hospitalization days and postoperative pain compared with the more commonly used chest tube with water-sealed bottle when a strict postoperative curative procedure was performed.
Collapse
Affiliation(s)
- Zihan Cui
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| | - Yuejuan Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| | - Chun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| | - Jun Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical college of Soochow University, Suzhou, China
| |
Collapse
|
10
|
Parker MH, Newcomb AB, Liu C, Michetti CP. Chest Tube Management Practices by Trauma Surgeons. J Surg Res 2019; 244:225-230. [PMID: 31301478 DOI: 10.1016/j.jss.2019.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/30/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers. MATERIALS AND METHODS We designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n = 1890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used. RESULTS The response rate was 39% (n = 734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10 y or fewer, and 79% 20 y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5 y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice. CONCLUSIONS Trauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.
Collapse
Affiliation(s)
- Michael H Parker
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Anna B Newcomb
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Chang Liu
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | | |
Collapse
|
11
|
Tang RD, Yu Y, Chan KJ, Fenton-Lee D. Chest drain management post-oesophagectomy: a survey of Australian and New Zealand surgeons. ANZ J Surg 2019; 89:465-467. [PMID: 31034147 DOI: 10.1111/ans.15010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Richard D Tang
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Yue Yu
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin J Chan
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Douglas Fenton-Lee
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Bai Q, Liu C, Cui Y. [Retrospective Analysis of Single Closed Chest Drainage in Superior Lobectomy
of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:157-160. [PMID: 30909995 PMCID: PMC6441115 DOI: 10.3779/j.issn.1009-3419.2019.03.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
背景与目的 目前,肺上叶切除术后留置单管胸腔引流还是双管胸腔引流管仍存在争议,本研究对因肺癌行肺上叶切除术、常规淋巴结清扫术后留置单根胸腔闭式引流管患者的术后引流相关并发症进行统计分析,评价引流效果。 方法 回顾性分析2012年4月-2017年5月入住北京友谊医院胸外科因肺癌行肺上叶切除术、常规淋巴结清扫术后放置单根引流管患者的临床资料,评价单根胸腔闭式引流管的引流效果。 结果 301例患者行肺上叶切除术、常规淋巴结清扫术后放置单根胸腔引流管,术后并发症发生率为9.3%,其中胸腔引流管相关并发症占5.64%。 结论 肺上叶切除术、常规淋巴结清扫术后单管胸腔闭式引流的引流效果不亚于双管引流。
Collapse
Affiliation(s)
- Qiang Bai
- Department of Thoracic Surgery, Beijing Friendship Hospital, Beijing 100050, China
| | - Chunquan Liu
- Department of Thoracic Surgery, Beijing Friendship Hospital, Beijing 100050, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital, Beijing 100050, China
| |
Collapse
|
13
|
Kheir F. Postoperative chest tube management for patients undergoing lobectomy: evidence-based practice. J Thorac Dis 2018; 10:S4130-S4132. [PMID: 30631573 DOI: 10.21037/jtd.2018.10.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fayez Kheir
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
14
|
Current Practices in the Management of Pulmonary Ground-Glass Opacities: A Survey of SICT Members. Ann Thorac Surg 2018; 106:1504-1511. [PMID: 30086278 DOI: 10.1016/j.athoracsur.2018.06.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several gray areas and controversies exist concerning the management of pulmonary ground-glass opacities (GGOs), and there is a lack of consensus among clinicians on this topic. One of the main aims of the Italian Society of Thoracic Surgery is to promote education and research, so we decided to perform a survey on this topic to estimate current trends in practice in a large sample of thoracic surgeons. METHODS A total of 160 thoracic surgeons responded, namely, completed our questionnaire (response rate, 53%; 160 of 302). The survey was composed of 36 questions divided into six subsections: (1) demographic characteristics of the respondents; (2) terminology and taxonomy; (3) radiologic and radiometabolic evaluation; (4) diagnostic approach and indications for surgery; (5) surgical management; and (6) radiologic surveillance. RESULTS We observed some divergence of opinion regarding the definition of mixed GGOs, the role of 18F fluorodeoxyglucose positron emission tomography and computed tomography scans, indications for nonsurgical biopsy, intraoperative techniques for localizing GGOs, indications for surgery, extension of lung resection and lymph node dissection according to the radiologic scenario, use of intraoperative frozen section analysis, and radiologic surveillance of pure GGOs. CONCLUSIONS This topic warrants more investigation in the future. An upcoming consensus conference of Italian Society of Thoracic Surgery experts (also open to experts in other specialties) could provide updated indications for GGO management based on the literature, expert opinions, and the results of the present survey.
Collapse
|
15
|
Lai Y, Wang X, Zhou H, Kunzhou PL, Che G. Is it safe and practical to use a Foley catheter as a chest tube for lung cancer patients after lobectomy? A prospective cohort study with 441 cases. Int J Surg 2018; 56:215-220. [PMID: 29936194 DOI: 10.1016/j.ijsu.2018.06.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/06/2018] [Accepted: 06/10/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study was conducted to explore the feasibility and safety of postoperative chest drainage with a Foley catheter for lung cancer patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS Data from lung cancer patients who underwent a VATS lobectomy with insertion of a catheter (Foley catheter or 28-F chest tube) were analysed. A total of 441 patients were included preoperatively for participation, with 208 patients in the Foley catheter group and 233 in the 28-F group. RESULTS In the Foley catheter group, a shorter mean number of days was required until chest tube removal after lobectomy (2.6 ± 1.3 vs. 3.5 ± 2.0 d, P < 0.001) and postoperative length of stay was shorter (3.8 ± 2.5 vs. 5.2 ± 4.1 d, P < 0.001); The 28-F group had a higher average VAS score than did the Foley catheter group at 6 h (P = 0.025), and 48 h (P < 0.001) after VATS lobectomy as well as at 6 h, 24 h, 48 h, 72 h, 30 days and 90 days after chest tube removal (P < 0.001). Regarding postoperative pulmonary complications (PPCs) and chest tube removal-related complications, the rate of PPCs was not found to be significant, and a significantly higher proportion of disordered wound healing at the drainage site was observed in the 28-F group (5.8%, 12/208 vs. 11.6%, 27/233; P = 0.043). CONCLUSION The study indicated that placement of Foley catheter vs. 28-F chest tube was associated with a statistically significant but clinically modest reduction in pain, with shorter mean days until chest tube removal after lobectomy, shorter in-hospital stay, and a smaller proportion of disordered wound healing at the drainage site. These results indicate the feasibility and safety of postoperative chest drainage with a Foley catheter for lung cancer patients undergoing VATS lobectomy. CLINICAL REGISTRATION NUMBER ChiCTR1800014816.
Collapse
Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou Area, Chengdu, Sichuan Province, 610041, PR China
| | - Xin Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou Area, Chengdu, Sichuan Province, 610041, PR China
| | - Hongxia Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou Area, Chengdu, Sichuan Province, 610041, PR China
| | - Pengfei Li Kunzhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou Area, Chengdu, Sichuan Province, 610041, PR China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou Area, Chengdu, Sichuan Province, 610041, PR China.
| |
Collapse
|
16
|
Abstract
Insertion, management, and withdrawal of chest tubes is part of the routine activity of thoracic surgeons. The selection of the chest tube and the strategy for each of these steps is usually built on knowledge, practice, experience, and judgment. The indication to insert a chest tube into the pleural cavity is the presence of air or fluid within it. Various types and sizes of chest tubes are now commercially available.
Collapse
Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy.
| | - Daniele Diso
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Ospedale S.Andrea, Rome, Italy
| | - Ilaria Onorati
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy
| |
Collapse
|
17
|
Oncel M, Sunam GS, Yildiran H. Management of Chest Tubes for Thoracic Surgery. Ann Thorac Surg 2016; 102:2138-2139. [PMID: 27847059 DOI: 10.1016/j.athoracsur.2016.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Murat Oncel
- Selcuk University Medical Faculty, Department of Thoracic Surgery, Alaeddin Keykubat Kampüsü, 42000, Konya, Turkey.
| | - Guven Sadi Sunam
- Selcuk University Medical Faculty, Department of Thoracic Surgery, Alaeddin Keykubat Kampüsü, 42000, Konya, Turkey
| | - Huseyin Yildiran
- Selcuk University Medical Faculty, Department of Thoracic Surgery, Alaeddin Keykubat Kampüsü, 42000, Konya, Turkey
| |
Collapse
|
18
|
New Fast-Track Concepts in Thoracic Surgery: Anesthetic Implications. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|