ObjectiveTo discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.MethodsThe online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis.ResultsA total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups.ConclusionIt is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
ObjectiveTo explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery.MethodsThe clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery.ResultsLogistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery.ConclusionFor elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.
ObjectiveTo compare clinical results between single and double chest tube applications after lung cancer resection, and explore the role of single chest tube in postoperative fast track recovery. MethodNinety-three patients with lung cancer who underwent lobectomy between March and December of 2009 in West China Hospital of Sichuan University were included in this study. All the patients were divided into a single-tube group including 46 patients (39 males and 7 females) with their age of 58.4±9.5 years, and a double-tube group including 47 patients (32 males and 15 females) with their age of 58.2±9.0 years. Drainage amount, duration, postoperative hospital stay, and incidences of pneumothorax and pleural effusion after removal of chest tubes were compared between the 2 groups. ResultsThe percentage of patients undergoing complete video-assisted thoracic surgery (VATS) of the double-tube group was significantly higher than that of the single-tube group, and the percentage of patients undergoing thoracotomy of the double-tube group was significantly lower than that of the single-tube group (P < 0.05). Drainage amount of the double-tube group was significantly larger than that of the single-tube group (824.4±612.5 ml vs. 510.7±406.7 ml, P < 0.05). There was no statistical difference in drainage duration, postoperative hospital stay, the incidences of subcutaneous emphysema, pneumothorax, pleural effusion or re-insertion of chest drain between the 2 groups (P > 0.05). ConclusionClinical results of single chest tube is better than or equivalent to those of double chest tubes after lung cancer resection, and drainage duration of single chest tube application might be shorter.
ObjectiveTo evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy in fast track recovery. MethodsBetween July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of 47±11 years. Central venous catheter and 26F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of 52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. ResultsNo statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group (P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group (P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. ConclusionThe use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.
ObjectiveWe aimed to further investigate the feasibility of using small bore chest tubes or even without chest tube insertion after da Vinci robot-assisted thoracic surgery. MethodsWe retrospectively analyzed initial 70 patients between September 12, 2014 and March 30, 2015 as a control group at the department of thoracic surgery, the First Affiliated Hospital of Zhejiang University, and proposed four schemes. There are 31 males and 39 females with mean age of 57.1±9.8 (ranged from 30-80 years). We applied those four schemes for the last 30 patients as an experimental group. There are 12 males and 18 females with mean age of 58.8±8.1 (ranged 42-73 years). ResultsThe days in hospital after surgery ranged 2-25 days and there was no severe complication. After the surgery, the pain scores of the trial group are lower than that of the control group. And the schemes 1 and schemes 2 of trial group reduced significantly than the control group (P<0.05). There is no significant difference of the rate of the complication caused by poor drainage between the trial group and the control group (P>0.05). But the pain score after surgery is lower than that of the control group (P<0.05). ConclusionOptimizing thoracic drainage strategy after da Vinci robot-assisted thoracic surgery is safe, possible and helpful to relieve postoperative pain.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.
ObjectiveTo compare the incidence of complications after removal of chest drainage tube in the early and late stages after sublobectomy for non-small cell lung cancer (NSCLC), and to analyze the factors affecting postoperative pleural drainage volume (PDV), so as to explore the countermeasures and achieve rapid postoperative rehabilitation. MethodsThe patients with NSCLC who underwent minimally invasive sublobectomy in our hospital from January to October 2021 were enrolled. According to the median time of extubation, the patients were divided into an early extubation group (time with tube≤3 days) and a late extubation group (time with tube>3 days). The patients were matched via propensity score matching with a ratio of 1:1 and a caliper value of 0.02. The incidence of complications and perioperative parameters after removal of the thoracic drainage tube were analyzed and compared between the two groups, and univariate and multiple linear regression analyses were performed. ResultsA total of 157 patients were enrolled, including 79 males and 78 females, with an average age of (58.22±11.06) years. There were 76 patients in the early extubation group, 81 patients in the late extubation group, and 56 patients were in each group after propensity score matching. Compared with late extubation group, there was no significant difference in the incidence of infection after extubation (10.7% vs. 16.1%, P=0.405) or pleural effusion after extubation (5.4% vs. 3.6%, P=0.647) in early extubation group, and there was no second operation in both groups. Univariate analysis showed that smoking history (P=0.001), postoperative serum albumin reduction value (P=0.017), surgical approach (P=0.014), lesion location (P=0.027), differentiation degree (P=0.041), TNM stage (P=0.043), number of dissected lymph nodes (P=0.016), and intraoperative blood loss (P=0.016) were infuencing factors for increased postoperative PDV. Multiple linear regression analysis showed that smoking history (P=0.002), postoperative serum albumin reduction value (P=0.041), and the number of dissected lymph nodes (P=0.023) were independent risk factors for increased postoperative PDV. ConclusionThere is no significant difference in the incidence of complications after extubation between early and late extubations. Preoperative smoking history, excessive postoperative serum albumin decreases, and excessive number of dissected lymph nodes during the surgery are independent risk factors for increased postoperative PDV.
ObjectiveTo evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube.MethodsThis study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups.ResultsFinally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL,P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000].ConclusionCompared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.