Postoperative Drainage with One Chest Tube Is Appropriate for Pulmonary Lobectomy: A Randomized Trial

Abstract

To expand postoperative residual lungs after pulmonary lobectomy, thoracic drainage with two chest tubes has been recommended. Several studies recently demonstrated that postoperative drainage with one chest tube (PD1) was as safe as that with two chest tubes (PD2). However, most of the patients in those studies underwent lobectomy by standard thoracotomy. Although the number of pulmonary lobectomies by video-assisted thoracic surgery (VATS) has been increasing in recent years, there have been no reports that compared PD1 with PD2 after pulmonary lobectomy, including that by VATS. To elucidate whether postoperative management with PD1 is as safe as that with PD2, we conducted a randomized controlled trial. Lung cancer patients who underwent lobectomies with mediastinal nodal dissection in our hospital were assigned to one of two groups: one chest tube placed in PD1 group and two chest tubes placed in PD2 group. A total of 108 patients were registered in the study. There were no significant differences in the age, gender, pathological stage or histological type between two groups. Since the residual lung expansion was good in both groups, there were no patients who needed thoracentesis. There were no significant differences in the number of cases with pleurodesis, the amount/duration of drainage or the pain of the patients between two groups. In conclusion, since PD1 has advantages in saving cost and time and in low risk of transcutaneous infection, PD1 is appropriate after pulmonary lobectomy by VATS and by open thoracotomy.

Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better?

“…Generally speaking, chest tube drainages were usually applied for patients suffering from pneumothorax who should be admitted to hospital following the failure of needle aspiration (3). And other indications for chest tube drainage included hemothorax (49,50), pleural effusion (51-53), pleural empyema (54,55), and major thoracic surgery (56)(57)(58). The approaches to insert chest tube drainage into body parts include axillary or anterior approach.…”

The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy

“…According to the clinical evidences, the use of 2 chest tubes currently appears to be reasonable when a bilobectomy is performed, to allow a complete lung re-expansion, avoiding the risk of pleural spaces development, which is intrinsically present in this surgical procedure. A recent RCT, comparing patients with one or two chest tubes following lobectomy, demonstrated that there was no statistically significant difference in thoracentesis, the number of cases with pleurodesis, the amount and duration of drainage or the pain of the patients between one-tube and two-tube groups (19).…”

Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis

“…The initial literature search yielded 738 citations, of which 5 studies were included (4 RCTs and 1 nRCTs) [ 3 – 7 ]. All eligible studies were published between 2003 and 2014.…”

“…Theoretically, single tube chest drainage is easier to insert and causes less pain and discomfort for the patient during both the insertion and while the tube is in the chest compared with double tube drainage, but single tube drainage has the possibility of inadequate chest drainage. Although some recent studies have compared the effectiveness of the two methods, there are no available data to support which of these treatments is more effective, and there are no evidence-based consensus recommendations for the optimal chest tube method to be used in pulmonary lobectomy [ 4 – 7 ].…”