There is no evidence concerning the appropriate drainage volume for indicating chest tube removal after pulmonary lobectomy. A prospective multi-institutional cohort study was designed to elucidate the safety of early chest tube removal after thoracoscopic lobectomy.
Between April 2009 and November 2011, 310 patients with suspected or histologically documented lung cancer were screened. Patients without air leakage or bloody, chylous, or purulent pleural effusion underwent chest tube removal on the day after thoracoscopic lobectomy, independent of the drainage volume. The subjects were classified into three groups as tertiles according to the drainage volume that was observed for approximately 24 h after surgery. The associations between the drainage volume and the development of complications were investigated, with several clinical factors taken into account.
The 162 patients who were enrolled underwent early chest tube removal via this protocol and were classified into three groups according to their drainage volume (0–219 mL, n = 52; 220–349 mL, n = 56; and ≥ 350 mL, n = 54). A 7F backup tube placed within the dead space to prevent troubles was removed by postoperative day 4 in all patients because nothing happened. Univariate and multivariate analyses showed that the drainage volume was not associated with the risk of complications.
Early removal of the chest tube on the day after thoracoscopic lobectomy appears to be a safe treatment protocol in patients without air leakage or bloody, chylous, or purulent pleural effusion; however, careful surveillance is needed for patients who have a drainage volume of ≥ 350 mL/day.
Clinical registration number
University Hospital Medical Information Network Clinical Trials Registry, 000028971 (Japan).
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Younes RN, Gross JL, Aguiar S, Haddad FJ, Deheinzelin D. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg. 2002;195:658–62.
Brunelli A, Beretta E, Cassivi SD, Cerfolio RJ, Detterbeck F, Kiefer T, et al. Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg. 2011;40:291–7.
Refai M, Brunelli A, Salati M, Xiume F, Pompili C, Sabbatini A. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg. 2012;41:820–3.
Cerfolio RJ, Pickens A, Bass C, Katholi C. Fast-tracking pulmonary resections. J Thorac Cardiovasc Surg. 2001;122:318–24.
Nakanishi R, Fujino Y, Yamashita T, Oka S. A prospective study of the association between drainage volume within 24 hours after thoracoscopic lobectomy and postoperative morbidity. J Thorac Cardiovasc Surg. 2009;137:1394–9.
Nakanishi R, Yamashita T, Shinohara S, Kato M, Miura T. Early removal of chest tube after thoracoscopic lobectomy. Kyosai Med J. 2013;62:206–10 (article in Japanese).
Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.
Swanson SJ, Herndon JE, D’Amico TA, Demmy TL, McKenna RJ Jr, Green MR, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-A prospective, multi-institution feasibility study. J Clin Oncol. 2007;25:4993–7.
Okada M, Sakamoto T, Yuki T, Mimura T, Miyoshi K, Tsubota N. Hybrid surgical approach of video-assisted minithoracotomy for lung cancer: significance of direct visualization on quality of surgery. Chest. 2005;128:2696–701.
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 remival following lobectomy. World J Surg. 2014;38:60–7.
Bertholet JW, Joosten JJ, Keemers-Gels ME, van den Wildenberg FJ, Barendregt WB. Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks. Interact Cardiovasc Thorac Surg. 2011;12:28–31.
Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg. 2008;135:269–73.
McKenna RJ Jr, Mahtabifard A, Pickens A, Kusuanco D, Fuller CB. Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy. Ann Thorac Surg. 2007;84:1663–8.
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.
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.
Xie HY, Xu K, Tang JX, Bian W, Ma HT, Zhao J, et al. A prospective randomized, controlled trial deems a drainage of 300 mL/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg. 2015;21:200–5.
Wang NS. The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura. Am Rev Respir Dis. 1975;111:12–20.
Li J. Ultrastructural study on the pleural stomata in human. Funct Dev Morphol. 1993;3:277–80.
Miserocchi G. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J. 1997;10:219–25.
Zocchi L. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J. 2002;20:1545–58.
Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;20:455–63.
Nakanishi R, Fujino Y, Oka S, Odate S. Video-assisted thoracic surgery involving major pulmonary resection for central tumors. Surg Endosc. 2010;24:161–9.
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.
Jiang H, Wang J, Yuan DF, Fang JW, Li Z. Feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy. Indian J Cancer. 2014;51:60–2.
Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE, Landreneau RJ, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–9.
Hristova R, Pompili C, Begum S, Salati M, Kefaloyannis M, Tentzeris V, et al. An aggregate score to predict the risk of large pleural effusion after pulmonary lobectomy. Eur J Cardiothorac Surg. 2015;48:72–6.
Light RW. Pleural diseases. Dis Mon. 1992;38:266–331.
Olgac G, Cosgun T, Vayvada M, Ozdemir A, Kutlu CA. Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy. Interact Cardiovasc Thorac Surg. 2014;19:650–5.
This study was supported by research grants from the Kyosai Medical Society (No. 20–27 to Ryoichi Nakanishi).
This article is based on the data of a study first reported in the Kyosai Medical Journal 2013; 62:206–10 (article in Japanese).
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Nakanishi, R., Fujino, Y., Kato, M. et al. Early chest tube removal after thoracoscopic lobectomy with the aid of an additional thin tube: a prospective multi-institutional study. Gen Thorac Cardiovasc Surg 66, 723–730 (2018). https://doi.org/10.1007/s11748-018-0993-z