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  Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 51  |  Issue : 6  |  Page : 60-62
 

Feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy


1 Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
2 Department of Thoracic Surgery, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
3 Department of Thoracic Surgery, Weifang Traditional Chinese Hospital, Weifang 261041, China
4 Zhangjiang Center for Translational Medicine, Shanghai 201203, China

Date of Web Publication24-Feb-2015

Correspondence Address:
Dr. H Jiang
Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250021
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.151987

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 » Abstract 

Objective: The aim was to evaluate the feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy (CVATL). Methods: Retrospective analysis was performed on effects of chest tube removal on patients with lung cancer after pulmonary lobectomy between November 2013 and October 2014. 154 eligible patients included 97 cases for CVATL and 57 cases for open thoracic lobectomy. Patients with CVATL were divided randomly into experimental group (EG) and control group (CG), in which 51 patients in EG had chest tube removal on the 2 nd day after operation; 46 patients in CG had the tube removal when the drainage volume <100 ml/day. Patients in open thoracic lobectomy group (OG) had the tubes removal as CG. The drainage volumes of the 1 st and 2 nd 24 h after operation, duration of chest tubes, cases of pain alleviation, and recurrent pleural effusions requiring reintervention were measured. Results: The average drainage volume of the 1 st 24 h after operation of CVATL group from EG and CG was significantly reduced than that in OG (260.41 ml vs. 353.16 ml, P < 0.001). The average drainage volume of the 2 nd 24 h after operation of CG was significantly reduced than that in OG (163.91 ml vs. 222.98 ml, P < 0.001). The average duration of chest tube of CG for 2.98 days showed significant different compared with OG for 3.81 days (P < 0.001). Chest tube removal in CVATL group increased more chest pain alleviation than OG (80.4% vs. 56.1%, P = 0.001). The frequencies of recurrent pleural effusions requiring reintervention were 5.88% (3/51), 4.35% (2/46) and 5.26% (3/57), respectively, which had no significant differences between three groups (P = 1.000). Conclusions: Complete video-assisted thoracic lobectomy brings less drainage volume after operation. Early removal of chest tube in CVATL shows feasible and safe and demonstrates that it may reduce postoperative pain and help fast recovery.


Keywords: Chest tube, pulmonary lobectomy, video-assisted thoracic surgery


How to cite this article:
Jiang H, Wang J, Yuan D F, Fang J W, Li Z. Feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy. Indian J Cancer 2014;51, Suppl S2:60-2

How to cite this URL:
Jiang H, Wang J, Yuan D F, Fang J W, Li Z. Feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy. Indian J Cancer [serial online] 2014 [cited 2021 Nov 30];51, Suppl S2:60-2. Available from: https://www.indianjcancer.com/text.asp?2014/51/6/60/151987

Jiang HFNx01, Wang JFNx01
FNx01Jiang H and Wang J contributed equally to the study.



 » Introduction Top


Surgery is now developing toward minimal invasion and fast recovery. Complete video-assisted thoracic lobectomy (CVATL) has been performed in thoracic surgery extensively for advantages such as micro-invasion, low complication, low mortality, fast recovery, and satisfied prognosis. [1],[2],[3] Fast recovery after operation has been the hotspot of recent researches. Postoperative pain not only increases patient suffering, but also increases the risk of infection and prolongs the length in hospital. The pain usually is caused by incision and irritation of chest tube. The conventional criterion for the timing of chest tube removal is when the drainage volume is <100 ml/day. The duration is nearly 3-4 days. The aim of the current study was to evaluate the feasibility and safety of early chest tube removal after CVATL.


 » Methods Top


We collected data of patients who underwent pulmonary lobectomy for lung cancer between November 2013 and October 2014 in Department of Thoracic Surgery of Provincial Hospital affiliated to Shandong University. Approval for the study was obtained from the Ethics Committee of the hospital, and written consents were obtained from all patients before operation.

The eligible patients receiving CVATL were randomized into experimental group (EG) and control group (CG) after operation, and the patients receiving open thoracic lobectomy served as lobectomy group (OG). The exclusive criteria: (1) Liver function is abnormal or with hypoproteinemia; (2) no single lobe excision with systematic lymph node dissection; (3) pleural cavity closure or severe adhesions; (4) progressive hemothorax; (5) persistent air leak; (6) pleural empyema or chylothorax. A total of 154 patients was enrolled in this study, in which 51 patients were enrolled in EG and 46 in CG and 57 in OG.

The chest tube was placed in the 7 th intercostal space in the midaxillary line at the end of the operation. An additional mushroom catheter was placed in the 2 nd intercostal space in the midclavian line when upper lobectomy. The chest tube connected to water-sealed drainage bottle. The chest radiograph examination was taken on the 1 st day, 1-week and 1-month after operation, respectively.

The criterion for removal of chest tube: (1) Chest radiograph showed that the residual lungs reexpanded well; (2) no air leak from chest tube; (3) no hemothorax, pleural empyema, or chylothorax. (4) Regardless of the drainage volume, the chest tubes were removed on the 2 nd day after operation in EG and removed when the drainage volume <100 ml/day in CG and OG.

The drainage volumes of the 1 st and 2 nd 24 h after operation, the drainage duration, cases of pain alleviation, and recurrent pleural effusions requiring pleurocentesis or reinsertion of a chest tube in 1-month after operation were measured.

Statistical analysis

The differences were analyzed by SPSS (SPSS Inc., Chicago, USA) for Windows statistical software (version 17.0). The means were compared by t-test or nonparametric test. The frequencies of different groups were compared by Chi-square test. The difference was considered significant when P < 0.05.


 » Results Top


In [Table 1], there were no significant differences in age and gender between three groups (P > 0.05). The average drainage volume of the 1 st 24 h after operation of CVATL group was 260.41 ml while the OG 353.16 ml. The difference was significant (t = −8.707, P < 0.001). The average drainage volume of the 2 nd 24 h after operation of CG was 163.91 ml, while the OG 222.98 ml. The difference was significant (t = −6.131, P < 0.001). The average duration of chest tube of CG and OG was 2.98 days and 3.81 days, respectively. The difference was significant (Z = −5.589, P < 0.001). The percentages of pain alleviation after chest tube removal in CVATL group were 80.4%, while the OG 56.1%. The difference was significant (χ2 = 10.364, P = 0.001). The cases of patients who were given thoracentesis for recurrent pleural effusions in EG, CG, and OG were 3, 2, and 3, respectively. The frequencies of recurrent pleural effusions requiring reintervention were 5.88% (3/51), 4.35% (2/46), and 5.26% (3/57), respectively, which did not show significant differences among the three groups (χ2 = 0.252, P = 1.000).
Table 1: Clinical data and statistic results

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 » Discussion Top


Clinical operation is developing toward more minor invasion and fast recovery in recent years. Thoracic drainage after operation is used to discover the progressive hemothorax as quickly as possible and drain the pleural effusion or air. However, the chest tube often leads to intercostal nerve impairment and chest pain. [4] Early removal of the chest tube without increasing the risk of postoperative complications is the better way that we could effectively release pain, decrease pulmonary complications, and shorten duration in hospital.

The conventional criteria for chest tube removal are established based on observation on the results of placing and removing the tubes after operation. These criteria have shown great improvement for patients after chest open surgery. However, the problem is that the duration of drainage may take a long time. In German, the average length of thoracic drainage was 4.9 ± 2.8 days. [5] Recently, some studies [6],[7],[8] have showed that early removal of the chest tube is possible and feasible when drainage volume was <200, 300 or 500 ml/day without other contraindications. The chest tube was even removed in 2 h after operation. [9] In some thoracoscopic pulmonary regional resection without chest tube placement, the satisfied results were obtained. [10],[11] Göttgens et al. reported that it was 58.8% safe to remove the chest tube within 24 h and in 82.5% within 48 h in patients after complete video-assisted thoracic surgery (bi-) lobectomy. [12] We found that there were only 5.88% patients who need thoracentesis for recurrent pleural effusion when the chest tubes were removed on the 2 nd day after operation. No significant difference on the incidence of reintervention in our results indicates that removal of the chest tube on the 2 nd day after CVATL is feasible and safe. The reason may be attributed to the less effusion in CVATL. Our results also showed that the drainage volume of CVATL was significantly less than OG.

As we know, removal of chest tube can eliminate the irritation to intercostals nerve that causes the pain. Refai et al. reported that the removal of a chest tube reduced pain and improved ventilatory function regardless of surgical access and particularly in the early postoperative phase. [13] In our results, the percentages of pain alleviation after chest tube removal in CVATL group were 80.4% and significantly higher than OG, which indicated that the chest tube was the main cause for postoperative pain in patients undergoing CVATL. Therefore, the chest tube should be removed as soon as early in these patients.


 » Conclusion Top


Our results demonstrate that early removal of the chest tube after CVATL is feasible and safe, and would not increase the risk of reintervention for recurrent pleural effusions, and will contribute to a fast recovery.

 
 » References Top

1.
Villamizar NR, Darrabie MD, Burfeind WR, Petersen RP, Onaitis MW, Toloza E, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg 2009;138:419-25.  Back to cited text no. 1
    
2.
Jeon JH, Kang CH, Kim HS, Seong YW, Park IK, Kim YT, et al. Video-assisted thoracoscopic lobectomy in non-small-cell lung cancer patients with chronic obstructive pulmonary disease is associated with lower pulmonary complications than open lobectomy: A propensity score-matched analysis. Eur J Cardiothorac Surg 2014;45:640-5.  Back to cited text no. 2
    
3.
Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 2000;24:27-30.  Back to cited text no. 3
    
4.
Miyazaki T, Sakai T, Yamasaki N, Tsuchiya T, Matsumoto K, Tagawa T, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg 2014;62:58-63.  Back to cited text no. 4
    
5.
Linder A, Ertner C, Steger V, Messerschmidt A, Merk J, Cregan I, et al. Postoperative chest tube management: Snapshot of German diversity. Interact Cardiovasc Thorac Surg 2012;15:622-6.  Back to cited text no. 5
    
6.
Hessami MA, Najafi F, Hatami S. Volume threshold for chest tube removal: A randomized controlled trial. J Inj Violence Res 2009;1:33-6.  Back to cited text no. 6
    
7.
Zhang Y, Li H, Hu B, Li T, Miao JB, You B, et al. A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy. World J Surg 2014;38:60-7.  Back to cited text no. 7
    
8.
Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg 2014;45:241-6.  Back to cited text no. 8
    
9.
Sienel W, Mueller J, Eggeling S, Thetter O, Passlick B. Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study. Chirurg 2005;76:1155-60.  Back to cited text no. 9
    
10.
Ueda K, Hayashi M, Tanaka T, Hamano K. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg 2013;44:225-9.  Back to cited text no. 10
    
11.
Nakashima S, Watanabe A, Mishina T, Obama T, Mawatari T, Higami T. Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung. Surg Today 2011;41:774-9.  Back to cited text no. 11
    
12.
Göttgens KW, Siebenga J, Belgers EH, van Huijstee PJ, Bollen EC. Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies. Eur J Cardiothorac Surg 2011;39:575-8.  Back to cited text no. 12
    
13.
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;41:820-2.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1]

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