Early chest tube removal following single-direction versus conventional uniportal video-assisted thoracoscopic lobectomy: A retrospective cohort study
- VernacularTitle:单向式与常规单孔胸腔镜肺叶切除术后早期拔除胸腔引流管的回顾性队列研究
- Author:
Weigang CHEN
1
,
2
;
Hao ZHANG
3
;
Wenbin WU
4
;
Tian ZHAO
3
;
Miao ZHANG
4
;
Hui ZHANG
4
Author Information
1. 1. Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, P. R. China
2. 2.Department of Cardiothoracic Surgery, Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P. R. China
3. Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, P. R. China
4. Department of Cardiothoracic Surgery, Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P. R. China
- Publication Type:Journal Article
- Keywords:
Early chest tube removal;
single-direction;
uniportal video-assisted thoracoscopic surgery;
lobectomy
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(01):71-77
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the feasibility of early chest tube removal following single-direction uniportal video-assisted thoracoscopic surgery (S-UVATS) anatomical lobectomy. Methods The clinical data of consecutive VATS lobectomy by different surgeons in Xuzhou Central Hospital between May 2019 and February 2022 were retrospectively reviewed. Finally, the data of 1 084 patients were selected for analysis, including 538 males and 546 females, with a mean age of 61.0±10.1 years. These patients were divided into a S-UVATS group with 558 patients and a conventional group (C-UVATS) with 526 patients according to the surgical procedures. The perioperative parameters such as operation time, blood loss were recorded. In addition, we assessed the amount of residual pleural effusion and the probability of secondary thoracentesis when taking 300 mL/d and 450 mL/d as the threshold of chest tube removal. Results Tumor-negative surgical margin was achieved without mortality in this cohort. As compared with the C-UVATS group, patients in the S-UVATS group demonstrated significantly shorter operation time (P<0.001), less blood loss (P=0.002), lower rate of conversion to multiple-port VATS or thoracotomy (P=0.003), but more stations and numbers of dissected lymph nodes as well as less suture staplers (P<0.001). Moreover, patients in the S-UVATS demonstrated shorter chest tube duration, less total volume of thoracic drainage and shorter postoperative hospital stay, with statistical differences (P<0.001). After excluding patients of chylothorax and prolonged air leaks>7 d, subgroup analysis was performed. First, assuming that 300 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, patients in the S-UVATS group would report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Second, assuming that 450 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, the S-UVATS group would also report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Further multivariable logistic regression analysis indicated that S-UVATS was significantly negatively related to drainage volume>1 000 mL (P<0.05); whereas combined lobectomy, longer operation time, more blood loss and air leakage were independent risk factors correlated with drainage volume>1 000 mL following UVATS lobectomy (P<0.05). Conclusion The short-term efficacy of S-UVATS lobectomy is significantly better than that of the conventional group, indicating shorter operation time and less chest drainage. However, early chest tube removal with a high threshold of thoracic drainage volume probably increases the risk of secondary thoracentesis due to residual pleural effusion.
