Is a Chest Tube Necessary after Video-Assisted Thoracoscopic Mediastinal Tumor Resection?
24 December 2018
05 February 2019
01 April 2019 (online)
Background The omission of chest tubes after thoracoscopic procedures such as sympathectomy, lung biopsy, and lung resection has proven efficacious in decreasing pain and length of hospital stay in some cases. However, its safety for mediastinal diseases remains unclear. This study evaluated the feasibility and outcome of eliminating chest drains after video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection.
Methods We retrospectively investigated 70 patients receiving VATS mediastinal tumor resection in a single institution between January 2016 and November 2018. A total of 39 patients (drain group) received postoperative chest drains and 31 patients (no-drain group) did not. Group clinical outcomes and operation data were compared. A propensity score matching analysis was further performed to yield a fairer comparison.
Results Before propensity score matching, the no-drain group had a higher prevalence of cystic lesions, a shorter operative time, and less blood loss compared with the drain group (p = 0.015, p = 0.018, and p < 0.001, respectively). After matching, the group differences in these perioperative variables lost significance (p = 0.095, 0.4, and 0.2, respectively). The no-drain group had lower postoperative day 2 pain scores and shorter postoperative hospital stays than the drain group, regardless of whether they were matched (pain: p = 0.028; hospital stay < 0.001) or not (pain: p = 0.003; hospital stay < 0.001). No major adverse events occurred in either group during hospitalization or follow-up period.
Conclusion Eliminating chest drain placement after VATS mediastinal tumor resection may benefit some patients and decrease postoperative pain and hospital stay without increasing complications or compromising patient safety.
- 1 Refai M, Brunelli A, Salati M, Xiumè F, Pompili C, Sabbatini A. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg 2012; 41 (04) 820-822 , discussion 823
- 2 Lu TY, Chen JX, Chen PR. , et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today 2017; 47 (05) 606-610
- 3 Watanabe A, Watanabe T, Ohsawa H. , et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg 2004; 25 (05) 872-876
- 4 Ueda K, Hayashi M, Tanaka T, Hamano K. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg 2013; 44 (02) 225-229 , discussion 229
- 5 Yang SM, Wang ML, Hung MH. , et al. Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules. Ann Thorac Surg 2017; 103 (02) 462-468
- 6 Cui F, Liu J, Li S. , et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis 2016; 8 (08) 2226-2232
- 7 Li S, Jiang L, Ang KL. , et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg 2017; 51 (04) 689-693
- 8 Murakami J, Ueda K, Tanaka T, Kobayashi T, Kunihiro Y, Hamano K. The validation of a no-drain policy after thoracoscopic major lung resection. Ann Thorac Surg 2017; 104 (03) 1005-1011
- 9 Yim AP. Video-assisted thoracoscopic resection of anterior mediastinal masses. Int Surg 1996; 81 (04) 350-353
- 10 Wu CF, Gonzalez-Rivas D, Wen CT. , et al. Comparative short-term clinical outcomes of mediastinum tumor excision performed by conventional VATS and single-port VATS: is it worthwhile?. Medicine (Baltimore) 2015; 94 (45) e1975
- 11 Wu CF, Gonzalez-Rivas D, Wen CT. , et al. Single-port video-assisted thoracoscopic mediastinal tumour resection. Interact Cardiovasc Thorac Surg 2015; 21 (05) 644-649
- 12 Li Q, Sihoe A, Wang H. , et al. Short-term outcomes of single- versus multi-port video-assisted thoracic surgery in mediastinal diseases. Eur J Cardiothorac Surg 2018; 53 (01) 216-220
- 13 Kao CN, Chang CW, Hsieh MC, Liu YW, Chou SH. Pre-embedding subcutaneous suture for chest-tube insertion in uniportal video-assisted thoracoscopic surgery. J Thorac Dis 2017; 9 (10) E938-E940
- 14 Hung MH, Hsu HH, Chan KC. , et al. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg 2014; 46 (04) 620-625
- 15 Aitken RC. Measurement of feelings using visual analogue scales. Proc R Soc Med 1969; 62 (10) 989-993
- 16 Jones NL, Edmonds L, Ghosh S, Klein AA. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia 2013; 68 (02) 179-189