Is a Chest Tube Necessary after Video-Assisted Thoracoscopic Mediastinal Tumor Resection?

Abstract

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.

Efficacy and safety of omitting chest drains after video-assisted thoracoscopic surgery: a systematic review and meta-analysis

“…Eight studies reported postoperative pleural effusion without the need for drainage or thoracocentesis (27)(28)(29)(32)(33)(34)38,39). From four studies (one was RCT and two were non-RCTs) comprising each 110 patients in both the NCD group and the CD group (29,34,38), with no significant difference between the two groups and not difference on subgroup analysis. There was no heterogeneity among analyses (Table 3, Figure 5).…”

“…Ten studies with 1,079 patients were included, comprising 561 (52.0%) classified as NCD and 518 (48%) as CD. Among these, four (19,(32)(33)(34) were RCTs including 353 patients (33%) and six (27)(28)(29)(30)38,39) were non-RCTs including 726 patients (all retrospective but one). The number of patients for each individual study ranged from 49 to 333.…”

“…Additionally, duration of chest drainage in the CD group was reported by eight studies (27)(28)(29)(32)(33)(34)38,39), of which range of mean was from 1 day to 4.23 days.…”

“…One systematic review (18) published in 2010 including one randomized controlled trial (RCT) (19) and three observational studies (20)(21)(22), and another with meta-analysis (23) of nine observational studies (20,(24)(25)(26)(27)(28)(29)(30)(31) was published in 2018. Subsequently, additional three RCTs (32)(33)(34) and six observational studies (35)(36)(37)(38)(39)(40) were published.…”

Thoracoscopic surgery approach to mediastinal mature teratomas: a single-center experience

“…We also compared the chest tube stay and the postoperative hospital stay between the two grops and saw a statistically significant difference (p < 0.05). Removing chest drain after VATS may benefit some patients by decreasing postoperative pain and shortening hospital stays, without increasing complications or compromising patient safety [20].…”