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Nachira D, Bertoglio P, Ismail M, Napolitano AG, Calabrese G, Kuzmych K, Congedo MT, Sassorossi C, Meacci E, Petracca Ciavarella L, Chiappetta M, Lococo F, Solli P, Margaritora S. Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study. J Clin Med 2024; 13:430. [PMID: 38256564 PMCID: PMC10817031 DOI: 10.3390/jcm13020430] [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: 12/06/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES The aim of this study is to evaluate if the efficacy and safety of chest tube placement are influenced by the level of intercostal space insertion (uniportal VATS vs. biportal VATS) or by the type of drain employed (standard vs. smart coaxial drain). METHODS Data on patients who underwent either uniportal or biportal VATS upper lobectomies with lymphadenectomy were prospectively collected in three European centers. The uniportal VATS group with a 28 Fr standard chest tube (U-VATS standard) was compared with the uniportal VATS group with a 28 Fr smart drain (U-VATS smart), and U-VATS smart was also compared with biportal VATS with a 28 Fr smart drain inserted in the VIII intercostal space (Bi-VATS smart). RESULTS When comparing the U-VATS standard group with the U-VATS smart, a higher fluid output was recorded in the U-VATS smart (p: 0.004) in the III post-operative day (p.o.) and overall (p: 0.027), with a lower 90-day re-admission in the U-VATS smart (p: 0.04). The Bi-VATS smart group compared to U-VATS smart showed a higher fluid output in the I p.o. (p < 0.001), with no difference in total fluid amount or hospitalization. The Bi-VATS smart recorded a lower incidence (p < 0.001) of residual pleural space or effusion (p: 0.004) at chest X-rays prior to drain removal but a higher level of pain and chronic intercostal neuralgia (p: 0.03). CONCLUSIONS Chest tube insertion through the same incision space in uniportal VATS seems to be safe and effective. Smart drains can improve the fluid output in uniportal VATS, as if the drainage were inserted in a lower space (i.e., biportal VATS), but with less discomfort.
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Affiliation(s)
- Dania Nachira
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Mahmoud Ismail
- Division of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin, Humboldt University Berlin, 14467 Potsdam, Germany;
| | - Antonio Giulio Napolitano
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Giuseppe Calabrese
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Khrystyna Kuzmych
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Carolina Sassorossi
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Elisa Meacci
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
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Yang F, Wang X, Xu H, Aramini B, Zhu Y, Jiang G, Fan J. A novel drainage strategy using chest tube plus pleural catheter in uniportal upper lobectomy: A randomized controlled trial. Thorac Cancer 2022; 14:399-406. [PMID: 36562112 PMCID: PMC9891854 DOI: 10.1111/1759-7714.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this study we explored whether one pleural catheter plus single chest tube drainage could achieve a noninferior drainage effect when compared with the traditional two chest tubes in uniportal video-assisted thoracoscopic surgery (VATS) for an upper pulmonary lobectomy. METHODS Patients that underwent an upper pulmonary lobectomy from January to November 2020 were enrolled in this single-center, randomized, open-label, noninferiority trial. Prior to closure, patients were randomized to an intervention group who received an improved drainage strategy involving one pleural catheter with one chest tube (24 Fr), while traditional double chest tube drainage was applied for the control group. RESULTS A total of 390 patients entered the study, although 190 were excluded for changing nonuniportal surgical approaches or opting for nonlobectomy resections. Finally, 200 patients were randomized (100 in the intervention group and 100 in the control group). The baseline demographic and clinical characteristics were comparable between the groups. The incidence of pneumothorax in the intervention and control groups was similar on postoperative Day 1 (noninferiority, 10% vs. 13%, p = 0.658). In addition, there were no significant differences in secondary outcomes such as incidence of pneumothorax by Day 30, postoperative chest tube/pleural catheter removal time, amount of drainage on Day 1, total amount of drainage after operation, or postoperative hospitalization. A significantly lower pain score was observed in the intervention group (3.33 ± 0.68 vs. 3.68 ± 0.94, p = 0.003). CONCLUSIONS The new strategy is noninferior to double chest tube drainage after an upper pulmonary lobectomy offers superior pain control, and is recommended for an upper lobectomy by uniportal VATS.
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Affiliation(s)
- Fu Yang
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina
| | - Xing Wang
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina,Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Honglei Xu
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Beatrice Aramini
- Division of Thoracic SurgeryG.B. Morgagni‐L. Pierantoni Hospital, University of BolognaForliItaly
| | - Yuming Zhu
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Gening Jiang
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Jiang Fan
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina,Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
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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.
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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.)
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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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.
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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.
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Li P, Li S, Che G. Role of chest tube drainage in physical function after thoracoscopic lung resection. J Thorac Dis 2019; 11:S1947-S1950. [PMID: 31632794 DOI: 10.21037/jtd.2019.08.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Pengfei Li
- Department of Thoracic Surgery, West China Hospital, West China Medical Center, Sichuan University, Chengdu 610041, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, West China Medical Center, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, West China Medical Center, Sichuan University, Chengdu 610041, China
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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。
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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
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Shintani Y, Funaki S, Ose N, Kanou T, Kanzaki R, Minami M, Okumura M. Chest tube management in patients undergoing lobectomy. J Thorac Dis 2018; 10:6432-6435. [PMID: 30746183 DOI: 10.21037/jtd.2018.11.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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9
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French DG, Gilbert S. Technology and evidence-based care enhance postoperative management of chest drains. J Thorac Dis 2018; 10:6399-6403. [PMID: 30746174 DOI: 10.21037/jtd.2018.11.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, Dalhousie University, Queen Elizabeth II Hospital-Victoria Campus, Halifax, NS, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
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10
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French DG, Plourde M, Henteleff H, Mujoomdar A, Bethune D. Optimal management of postoperative parenchymal air leaks. J Thorac Dis 2018; 10:S3789-S3798. [PMID: 30505566 DOI: 10.21037/jtd.2018.10.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Air leaks are the most common complication after pulmonary resection. Enhanced recovery after surgery (ERAS) programs must be designed to manage parenchymal air leaks. ERAS programs should consider two components when creating protocols for air leaks: assessment and management. Accurate assessment of air leaks using traditional analogues devices, newer digital drainage systems, portable devices and chest X-rays (CXR) are reviewed. Published data suggests that digital drainage systems result in a more confident assessment of air leaks. The literature regarding the management of postoperative air leaks, including the number of chest tubes, the role of applied external suction, invasive maneuvers and discharge with a portable device is reviewed. The key findings are that a single chest drain is adequate in the majority of cases to manage an air leak, the use of applied external suction is unlikely to prevent or prolong an air leak, autologous blood patch pleurodesis may potentially shorten postoperative air leaks and there is sufficient data to support that patients can safely be discharged with a portable drainage system. There is also literature to support the design of protocols for management of postoperative air leaks. Standardization of postoperative care through ERAS programs will allow for the design of larger RCTs to better understand some of the controversies around the management of postoperative air leaks.
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Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Madelaine Plourde
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Harry Henteleff
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Aneil Mujoomdar
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Drew Bethune
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
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11
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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.
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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.
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12
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Deng B, Qian K, Zhou JH, Tan QY, Wang RW. Optimization of Chest Tube Management to Expedite Rehabilitation of Lung Cancer Patients After Video-Assisted Thoracic Surgery: A Meta-Analysis and Systematic Review. World J Surg 2018; 41:2039-2045. [PMID: 28289835 DOI: 10.1007/s00268-017-3975-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this meta-analysis and systematic review of published evidence was to optimize chest tube management for fast-track rehabilitation of lung cancer patients after video-assisted thoracic surgery (VATS). METHODS The PubMed, Web of Science, and EMBASE databases were searched to identify all studies that addressed the issue of chest tube management after VATS for lung cancer. Finally, 35 articles were included for analysis, i.e., 29 randomized controlled trials and 6 clinical trials. RESULTS After synthesis of the published evidence, the following protocol for chest tube drainage was formulated: (1) after VATS lung wedge resection, chest tube drainage can be omitted in selected cases; (2) normally, one 28Fr chest tube (or 19Fr Blake drain) is placed; (3) the use of a digital monitoring system is recommended; (4) in case of increasing pneumothorax or severe air leakage supported by digital recording system, the tube should be placed with active suction; and (5) the chest tube can be removed within 48 h postoperatively when air leakage is resolved and fluid drainage is <400 mL/day. CONCLUSIONS Further multicenter studies are warranted based on the variations of body sizes among different ethnicities.
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Affiliation(s)
- Bo Deng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Kai Qian
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Jing-Hai Zhou
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Qun-You Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China.
| | - Ru-Wen Wang
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
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13
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Abouarab AA, Rahouma M, Kamel M, Ghaly G, Mohamed A. Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A Systematic Review and Meta-analysis. J Laparoendosc Adv Surg Tech A 2018; 28:174-185. [DOI: 10.1089/lap.2017.0446] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ahmed A. Abouarab
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Kamel
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Galal Ghaly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Abdelrahman Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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14
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Hardin J, Strumwasser A, Grabo D, Kleinman J, Inaba K, Demetriades D. Evaluation of Single- versus Dual-Tube Thoracostomy after Thoracotomy for Trauma. Am Surg 2017. [DOI: 10.1177/000313481708301026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Draining the chest cavity with two chest tubes after thoracotomy for trauma is controversial. This article aims to determine whether using two tubes after thoracotomy for trauma is more effective than using a single tube. A 9-year retrospective review (2007–2015) was performed at our academic level I trauma center. All patients who underwent trauma thoracotomy (unilateral and bilateral) were included for analysis (n = 99). Patients with incomplete data, pediatric patients (age < 18), pregnant patients, and early deaths (<24 hours) were excluded. When analyzed by chest cavity, dual tubes have increased drainage bilaterally (P = 0.008) and require more days to clear the right chest (P = 0.002). Patients with dual tubes bilaterally are associated with increased intensive care unit length of stay (P = 0.05) and ventilator days (P = 0.04). Although dual chest tube insertion achieves greater drainage, it comes at the cost of increased time to clear the chest and is associated with worse outcomes in bilateral injuries. One chest tube may be sufficient post-trauma thoracotomy; routine placement of two chest tubes is not recommended.
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Affiliation(s)
- Jeremy Hardin
- Division of Trauma and Acute Care Surgery, LAC-USC Medical Center, Los Angeles, California
| | - Aaron Strumwasser
- Division of Trauma and Acute Care Surgery, LAC-USC Medical Center, Los Angeles, California
| | - Daniel Grabo
- Division of Trauma and Acute Care Surgery, LAC-USC Medical Center, Los Angeles, California
| | - John Kleinman
- Division of Trauma and Acute Care Surgery, LAC-USC Medical Center, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Acute Care Surgery, LAC-USC Medical Center, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Acute Care Surgery, LAC-USC Medical Center, Los Angeles, California
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15
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Wang C, Lyu M, Zhou J, Liu Y, Ji Y. Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better? J Thorac Dis 2017; 9:4027-4038. [PMID: 29268413 DOI: 10.21037/jtd.2017.08.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Needle aspiration and chest tube drainages are two main treatments for primary spontaneous pneumothorax (PSP). However, the application of needle aspiration or chest tube drainages has not reached a consensus. The aim of this study is to compare the needle aspiration with chest tube drainages in patients suffering with PSP and therefore help offer suggestions for clinical practice. Methods We searched literatures from PubMed, OVID and Web of Science from their inception to June 30, 2017. Continuous and dichotomous outcomes were expressed by weight mean difference (WMD) and risk ratio (RR) respectively, and each with 95% confidence intervals (CIs). We used the fixed effect or random effect model to perform quantitative synthesis. Results A total of 6 RCTs recruiting 458 participants were included in our analysis. On the basis of the six studies, our results indicated that compared with chest tube drainage applying needle aspiration shortened the hospital stay (WMD: ‒1.67 days; 95% CI: ‒2.25 to 1.08; P<0.001) and decreased hospitalization rate (RR: 0.40; 95% CI: 0.22-0.75; P=0.004). However, there was no difference regarding immediate success rate (RR: 1.01; 95% CI: 0.70-1.46; P=0.96) and one-year recurrence rate (RR: 0.89; 95% CI: 0.58-1.38; P=0.61). Conclusions In the light of this present research, it is necessary to apply needle aspiration into treating PSP to reduce hospitalization rate and shorten hospital stay. However, the two treatments have no significant difference with respect to immediate success rate, one-year recurrence rate, one-week success rate, three-month recurrence rate or complication rate.
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Affiliation(s)
- Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mengyuan Lyu
- Department of Laboratory Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yang Liu
- Department of Vascular Surgery, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yulin Ji
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
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16
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Gao S, Zhang Z, Aragón J, Brunelli A, Cassivi S, Chai Y, Chen C, Chen C, Chen G, Chen H, Chen JS, Cooke DT, Downs JB, Falcoz PE, Fang W, Filosso PL, Fu X, Force SD, Garutti MI, Gonzalez-Rivas D, Gossot D, Hansen HJ, He J, He J, Holbek BL, Hu J, Huang Y, Ibrahim M, Imperatori A, Ismail M, Jiang G, Jiang H, Jiang Z, Kim HK, Li D, Li G, Li H, Li Q, Li X, Li Y, Li Z, Lim E, Liu CC, Liu D, Liu L, Liu Y, Lobdell KW, Ma H, Mao W, Mao Y, Mou J, Ng CSH, Novoa NM, Petersen RH, Oizumi H, Papagiannopoulos K, Pompili C, Qiao G, Refai M, Rocco G, Ruffini E, Salati M, Seguin-Givelet A, Sihoe ADL, Tan L, Tan Q, Tong T, Tsakiridis K, Venuta F, Veronesi G, Villamizar N, Wang H, Wang Q, Wang R, Wang S, Wright GM, Xie D, Xue Q, Xue T, Xu L, Xu S, Xu S, Yan T, Yu F, Yu Z, Zhang C, Zhang L, Zhang T, Zhang X, Zhao X, Zhao X, Zhi X, Zhou Q. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis 2017; 9:3255-3264. [PMID: 29221303 PMCID: PMC5708414 DOI: 10.21037/jtd.2017.08.165] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B <0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B).
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Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | | | | | | | - Ying Chai
- Department of Thoracic Surgery, Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jin-Shing Chen
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - David Tom Cooke
- Section of General Thoracic Surgery, University of California, Davis Health System, Sacramento, CA, USA
| | - John B. Downs
- Department of Anesthesiology and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | | | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Seth D. Force
- Cardiothoracic Surgery, Emory University, The Emory Clinic, Atlanta, GA, USA
| | - Martínez I. Garutti
- Department of Anaesthesia and Postoperative Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Bo Laksáfoss Holbek
- Department of Cardiothoracic Surgery and Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome ‘Sapienza’, Rome, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mahmoud Ismail
- Charité Kompetenzzentrum für Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Hongjing Jiang
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Qianfoshan Hospital, Jinan 250014, China
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Gaofeng Li
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing 100049, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital Fourth Military Medical University, Xi’an 710038, China
| | - Yin Li
- Henan Cancer Hospital, Zhengzhou 450008, China
| | - Zhijun Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Eric Lim
- Imperial College and The Academic Division of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London, UK
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongyi Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shengyang 110042, China
| | - Kevin W. Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Haitao Ma
- Department of Thoracic Surgery, The First Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Yousheng Mao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Juwei Mou
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - Nuria M. Novoa
- Thoracic Surgery Service, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
| | - René H. Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Hiroyuki Oizumi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Cecilia Pompili
- Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangzhou General Hospital of Guangzhou Military Area Command, Guangzhou 510000, China
| | - Majed Refai
- Thoracic Surgery Department, United Hospitals of Ancona, Via San Vincenzo 5/f Polverigi, Ancona, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Erico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Michele Salati
- Unit of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | | | - Alan Dart Loon Sihoe
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Tang Tong
- Department of Thoracic Surgery, Second Affiliated Hospital of Jilin University, Changchun 130041, China
| | - Kosmas Tsakiridis
- Cardiac and Thoracic Department, Private Hospital “St.Lukes”, Thessaloniki, Greece
| | - Federico Venuta
- Department of Surgery “Paride Stefanini” - Thoracic Surgery Unit, Policlinico Umberto I, University of Rome SAPIENZA, Rome, Italy
| | - Giulia Veronesi
- Robotic Surgery, Division of Thoracic Surgery, Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | | | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ruwen Wang
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang 110015, China
| | - Gavin M. Wright
- Department of Surgical Oncology, St Vincent’s Hospital, Melbourne, Australia
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Deyao Xie
- Department of Cardiovascular and Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qi Xue
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Tao Xue
- Department of Thoracic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210008, China
| | - Shidong Xu
- Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin 150049, China
| | - Songtao Xu
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Fenglei Yu
- Department of Cardiovascular Surgery, Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lanjun Zhang
- Cancer Center, San Yat-sen University, Guangzhou 510060, China
| | - Tao Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical Hospital, Urumqi 830011, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin 300300, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200003, China
| | - Xuewei Zhao
- Department of Thoracic Surgery, Shanghai Changzheng Hospital, Shanghai 200000, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Filosso PL, Sandri A, Guerrera F, Roffinella M, Bora G, Solidoro P. Management of Chest Drains After Thoracic Resections. Thorac Surg Clin 2016; 27:7-11. [PMID: 27865329 DOI: 10.1016/j.thorsurg.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immediately after lung resection, air tends to collect in the retrosternal part of the chest wall (in supine position), and fluids in its lower part (costodiaphragmatic sinus). Several general thoracic surgery textbooks currently recommend the placement of 2 chest tubes after major pulmonary resections, one anteriorly, to remove air, and another into the posterior and basilar region, to drain fluids. Recently, several authors advocated the placement of a single chest tube. In terms of air and fluid drainage, this technique demonstrated to be as effective as the conventional one after wedge resection or uncomplicated lobectomy.
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Affiliation(s)
- Pier Luigi Filosso
- Department of Thoracic Surgery, University of Torino, Corso Dogliotti 14, Torino 10126, Italy.
| | - Alberto Sandri
- Department of Thoracic Surgery, University of Torino, Corso Dogliotti 14, Torino 10126, Italy
| | - Francesco Guerrera
- Department of Thoracic Surgery, University of Torino, Corso Dogliotti 14, Torino 10126, Italy
| | - Matteo Roffinella
- Department of Thoracic Surgery, University of Torino, Corso Dogliotti 14, Torino 10126, Italy
| | - Giulia Bora
- Department of Thoracic Surgery, University of Torino, Corso Dogliotti 14, Torino 10126, Italy
| | - Paolo Solidoro
- Unit of Pulmonology, San Giovanni Battista Hospital, Via Genova 3, Torino 10126, Italy
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Zhou D, Deng XF, Liu QX, Chen Q, Min JX, Dai JG. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis. J Cardiothorac Surg 2016; 11:88. [PMID: 27233984 PMCID: PMC4884434 DOI: 10.1186/s13019-016-0484-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. METHODS According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. RESULTS Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] -0.60; 95 % confidence intervals [CIs] -0.68-- 0.52; P < 0.00001], duration of drainage [WMD -0.70; 95 % CIs -0.90-- 0.49; P < 0.00001] and hospital stay [WMD -0.51; 95 % CIs -0.91-- 0.12; P = 0.01] compared to patients using a double tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57-1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42-1.58; P = 0.54]. CONCLUSION Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.
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Affiliation(s)
- Dong Zhou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Xu-Feng Deng
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Quan-Xing Liu
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Qian Chen
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Jia-Xin Min
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Ji-Gang Dai
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
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Yang M, Fan J, Zhou H, Du H, Qiu F, Lin L, Liu L, Li W, Che G. [What are the Advantages? A Prospective Analysis of 16 versus 28 French Chest Tube Sizes in Video-assisted Thoracoscopic Surgery Lobectomy of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 18:512-7. [PMID: 26302349 PMCID: PMC6000231 DOI: 10.3779/j.issn.1009-3419.2015.08.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 微创胸外科术后管理仍延用开放术后的方式，尤其是胸腔引流管的术后管理，本研究探讨胸腔镜（video-assisted thoracic surgery, VATS）肺叶切除术后应用胸腔引流管（16 F）对切口愈合延迟的影响，是否因引流管管径小而导致相关并发症的增多。 方法 选取2014年2月-2014年5月四川大学华西医院连续收治的163例肺癌行VATS肺叶切除术，分别应用引流管28 F（75例）和16 F（88例），分析术后胸腔积气、积液、皮下气肿、引流管持续时间、术后住院日、术后引流管拆线时间和切口愈合率。 结果 平均引流量和心律失常发生率在16 F组[(365±106) mL, 14.67%]明显低于28 F组[(665±217) mL, 4.5%]（P=0.030, 1, P=0.047）；术后胸腔积气、积液和皮下气肿在28 F组发生率（4.00%, 0.0%, 7.50%）与16 F组（4.50%, 3.41%, 6.82%）均无统计学差异（P < 0.999, P=0.025, 3, P=0.789）；引流管持续时间及术后平均住院日在16F组[(22.1±11.8) h, (4.23±0.05) d]与28 F组[(28.4±16.12) h, (4.57±0.16) d]均无统计学差异（P=0.12, P=0.078）；引流管拆线时间在16 F组（7.05±2.11）d明显短于28 F组（14.33±3.87）d（P=0.034）；切口一级愈合率在16 F组（95.45%）明显高于28 F组（77.73%）（P=0.039）。 结论 胸腔镜肺叶切除术后16 F和28 F引流临床效果相当，而16 F有助于引流管口快速愈合。
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Affiliation(s)
- Mei Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jun Fan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hongxia Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Heng Du
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fang Qiu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weimin Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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