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Comparison of the results of two chest tube managements during an enhanced recovery program after video-assisted thoracoscopic lobectomy: A randomized trial.

ABSTRACT: BACKGROUND:This study compared the results of the application of two different chest tube management systems; a drainage ball with low negative pressure and the more commonly used chest tube with water-sealed bottle, after video-assisted thoracoscopic (VATS) lobectomy. METHODS:A total of 60 patients undergoing lobectomy were enrolled into this prospective open label randomized clinical trial and equally divided into two groups. The data collected in the trial included age, gender, forced expiratory volume in 1?second (FEV1), blood loss, operation time, drainage volume, drainage time, length of stay, postoperative pain score according to the Visual Analogue Scale (VAS) within 24?hours after surgery and chest tube removal. This study was registered at ClinicalTrials.gov (NCT03598296). RESULTS:The characteristics of the patients were similar in both groups. Group ball patients had a lower pain score (after operation: 3.47?±?1.80 vs. 6.20?±?1.56, P

SUBMITTER: Cui Z

PROVIDER: S-EPMC6775025 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Comparison of the results of two chest tube managements during an enhanced recovery program after video-assisted thoracoscopic lobectomy: A randomized trial.

Cui Zihan Z Zhang Yuejuan Y Xu Chun C Ding Cheng C Chen Jun J Li Chang C Zhao Jun J

Thoracic cancer 20190902 10

<h4>Background</h4>This study compared the results of the application of two different chest tube management systems; a drainage ball with low negative pressure and the more commonly used chest tube with water-sealed bottle, after video-assisted thoracoscopic (VATS) lobectomy.<h4>Methods</h4>A total of 60 patients undergoing lobectomy were enrolled into this prospective open label randomized clinical trial and equally divided into two groups. The data collected in the trial included age, gender, ...[more]

PMID: 31475791

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Project description:BackgroundEnhanced recovery pathways or fast-tracking following surgery can decrease the rate of postoperative complications and hospital length of stay. The objectives of this study were to implement an enhanced recovery after surgery (ERAS) pathway for patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy, to assess the safety and efficiency of this protocol by measuring associated postoperative outcomes, and to compare the outcomes for patients in the ERAS group with the outcomes for patients in a propensity-matched control group.MethodsThe study was a prospective clinical trial. Patients who were scheduled to undergo VATS lobectomy at the Centre hospitalier de l'Université de Montréal in Montréal, Quebec, Canada, were enrolled between November 2015 and October 2016. The ERAS pathway was used for all enrolled patients. The primary outcome was the number and severity of complications measured by the Comprehensive Complication Index. Secondary outcomes included length of stay, readmission and recovery. Recovery of patients was measured using EQ-5D-5L preoperatively and at 1 week, 1 month and 4 months after surgery. Prospectively enrolled patients were propensity matched to historical controls.ResultsNinety-eight patients (36 men and 62 women) in the ERAS group and 98 patients in the control group (29 men and 69 women) were included in the analysis. The mean age was 65.2 ± 9.3 years, the mean body mass index (BMI) was 26.9 ± 5.9 kg/m2 and the median Charlson Comorbidity Index score was 2 (interquartile range [IQR] 2-3) in the ERAS group. In the control group, the mean age was 66.2 ± 9.4 years, the mean BMI was 27.4 ± 5.6 kg/m2 and the median Charlson Comorbidity Index score was 3 (IQR 2-3). A total of 23 patients (23.4%) in the ERAS group and 28 (28.6%) in the control group experienced 1 or more postoperative complications. The mean Comprehensive Complication Index score was 7.4 ± 16.8 in the ERAS group compared with 8.0 ± 14.3 in the control group (p = 0.79). The median postoperative length of stay was 3 days in the ERAS group and 5 days in the control group (p < 0.001). Five patients in the ERAS group and 4 patients in the control group were readmitted. The protocol adherence rate was 64.3%.ConclusionIt is feasible to implement an enhanced recovery protocol after VATS lobectomy. Although the pathway is still early in its development in Canada, implementation of an ERAS pathway after VATS lobectomy was associated with decreased length of stay, with no observable increase in complication or readmission rates.

Project description:BACKGROUND:In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa. METHODS:The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed. RESULTS:All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05). CONCLUSIONS:Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.

Project description:Background Although chest tube-omitted video-assisted thoracoscopic surgery (VATS) has been proven to be safe and efficacious, its universal application is precluded by a varying morbidity rate due to a lack of standardization. Since digital chest drainage has already shown improved accuracy and consistency in the management of postoperative air leak, we incorporated it in the strategy of intraoperative chest tube withdrawal, aiming to achieve better results. Methods We collected the clinical data of 114 consecutive patients who underwent elective uniportal VATS pulmonary wedge resection at the Shanghai Pulmonary Hospital from May 2021 to February 2022. Their chest tubes were withdrawn intraoperatively after an air-tightness test facilitated by digital drainage: the end flow rate had to be kept ≤30 mL/min for >15 s at the setting of −8 cmH2O suctioning. The recordings and patterns of the air suctioning process were documented and analyzed as potential standards of chest tube withdrawal. Results The mean age of the patients was 49.7±11.7 years. The mean size of the nodules was 1.0±0.2 cm. The location of the nodules encompassed all lobes, and 90 (78.9%) patients received preoperative localization. The postoperative morbidity and mortality rates were 7.0% and 0%, respectively. Six patients had clinically overt pneumothorax and two patients had postoperative bleeding that required intervention. All of the patients recovered on conservative treatment except for one case of pneumothorax that required additional tube thoracostomy. The median length of postoperative stay was 2 days; and the median time of suctioning, peak flow rate, and end flow rate were 126 s, 210 mL/min, and 0 mL/min, respectively. The median numeric rating scale for pain was 1 on postoperative day (POD) 1 and 0 on the day of discharge. Conclusions Chest tube-free VATS assisted by digital drainage is feasible with minimal morbidity. Its strength of quantitative air leak monitoring produces important measurements for the prediction of postoperative pneumothorax and future standardization of the procedure.

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Comparison of the results of two chest tube managements during an enhanced recovery program after video-assisted thoracoscopic lobectomy: A randomized trial.

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Comparison of the results of two chest tube managements during an enhanced recovery program after video-assisted thoracoscopic lobectomy: A randomized trial.

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