Safety and feasibility of no chest tube after thoracoscopic pneumonectomy: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Fuan ¹ , WANG Peng ¹ , LI Wendeng ² , MA Linchong ¹ ,  LI Qingxin ³

1. The Clinical Medical College of Ningxia Medical University, Yinchuan, 750004, P. R. China;
2. The Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
3. Department of Cardiothoracic Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, 730050, P. R. China;

Corresponding author：

LI Qingxin, Email: liqxchest@163.com

Keywords：

Pneumonectomy; video-assisted thoracoscopic surgery (VATS); chest drainage; systematic review/meta analysis

DOI：

10.7507/1007-4848.202012015

Video：

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Objective To discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.Methods The 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.Results A 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.Conclusion It is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.

Citation： HU Fuan, WANG Peng, LI Wendeng, MA Linchong, LI Qingxin. Safety and feasibility of no chest tube after thoracoscopic pneumonectomy: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1503-1510. doi: 10.7507/1007-4848.202012015 Copy

1.	Nakazawa S, Shimizu K, Mogi A, et al. VATS segmentectomy: Past, present, and future. Gen Thorac Cardiovasc Surg, 2018, 66(2): 81-90.
2.	Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer, 2016, 100: 114-119.
3.	Novoa NM, Jiménez MF, Varela G. When to remove a chest tube. Thorac Surg Clin, 2017, 27(1): 41-46.
4.	Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: A meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
5.	Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
6.	Russo L, Wiechmann RJ, Magovern JA, et al. Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung. Ann Thorac Surg, 1998, 66(5): 1751-1754.
7.	Park JB, Hwang JJ, Lee WS, et al. Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: Is it mandatory? J Thorac Dis, 2018, 10(8): 4812-4818.
8.	Liao HC, Yang SM, Hung MH, et al. Thoracoscopic surgery without drainage tube placement for peripheral lung nodules. Ann Thorac Surg, 2020, 109(3): 887-893.
9.	Ueda K, Haruki T, Murakami J, et al. No drain after thoracoscopic major lung resection for cancer helps preserve the physical function. Ann Thorac Surg, 2019, 108(2): 399-404.
10.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
11.	Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (MIBORS): Development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
12.	Lu TY, Chen JX, Chen PR, et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today, 2017, 47(5): 606-610.
13.	Nakashima S, Watanabe A, Mishina T, et al. Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung. Surg Today, 2011, 41(6): 774-779.
14.	Steunenberg BE, Aerts BAC, Groot HGWD, et al. Is it still necessary to leave a chest tube after video-assisted pulmonary wedge resection? Indian J Thoracic Cardiovasc Surg, 2017, 33(12): 1-5.
15.	Ueda K, Hayashi M, Tanaka T, et al. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg, 2013, 44(2): 225-229.
16.	Murakami J, Ueda K, Tanaka T, et al. The validation of a no-drain policy after thoracoscopic major lung resection. Ann Thorac Surg, 2017, 104(3): 1005-1011.
17.	Yang SM, Wang ML, Hung MH, et al. Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules. Ann Thorac Surg, 2017, 103(2): 462-468.
18.	Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
19.	张璐, 李星, 张亚年, 等. 单孔胸腔镜肺楔形切除术后不留置胸腔闭式引流管在快速康复中的应用. 江苏医药, 2018, 44(2): 157-161.
20.	王炯杰, 王新, 王雷, 等. 肺切除后无胸腔引流管适应症的临床研究. 世界肿瘤研究, 2020, 10(3): 59-63.
21.	霍宏健, 杨云龙. 胸腔镜治疗肺部炎性假瘤术后是否置胸管的对比研究. 科技视界, 2015, (33): 293.
22.	曹雄, 韩彪, 马敏杰, 等. 无管化治疗方式在肺大疱切除术中的应用. 中国胸心血管外科临床杂志, 2019, 26(5): 436-439.
23.	Lesser T, Doenst T, Lehmann T, et al. Lung bioposy without pleural drainage. Dtsch Arztebl Int, 2019, 116(19): 329-334.
24.	Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer, 2017, 17(1): 75.
25.	李庆新, 张宏伟, 晁栋, 等. 单操作孔全胸腔镜在胸部疾病诊断与治疗中的应用. 西北国防医学杂志, 2012, 33(5): 542-544.
26.	Klapper J, D'Amico TA. VATS versus open surgery for lung cancer resection: moving toward a minimally invasive approach. J Natl Compr Canc Netw, 2015, 13(2): 162-164.
27.	Cheng K, Yuan M, Xu C, et al. A chest tube may not necessary in children thoracoscopic lobectomy. Medicine (Baltimore), 2019, 98(26): e15857.
28.	Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin, 2005, 15(1): 105-121.
29.	Li P, Shen C, Wu Y, et al. It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: A meta-analysis. J Thorac Dis, 2018, 10(5): 2712-2721.
30.	Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.

1. Nakazawa S, Shimizu K, Mogi A, et al. VATS segmentectomy: Past, present, and future. Gen Thorac Cardiovasc Surg, 2018, 66(2): 81-90.
2. Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer, 2016, 100: 114-119.
3. Novoa NM, Jiménez MF, Varela G. When to remove a chest tube. Thorac Surg Clin, 2017, 27(1): 41-46.
4. Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: A meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
5. Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
6. Russo L, Wiechmann RJ, Magovern JA, et al. Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung. Ann Thorac Surg, 1998, 66(5): 1751-1754.
7. Park JB, Hwang JJ, Lee WS, et al. Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: Is it mandatory? J Thorac Dis, 2018, 10(8): 4812-4818.
8. Liao HC, Yang SM, Hung MH, et al. Thoracoscopic surgery without drainage tube placement for peripheral lung nodules. Ann Thorac Surg, 2020, 109(3): 887-893.
9. Ueda K, Haruki T, Murakami J, et al. No drain after thoracoscopic major lung resection for cancer helps preserve the physical function. Ann Thorac Surg, 2019, 108(2): 399-404.
10. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
11. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (MIBORS): Development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
12. Lu TY, Chen JX, Chen PR, et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today, 2017, 47(5): 606-610.
13. Nakashima S, Watanabe A, Mishina T, et al. Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung. Surg Today, 2011, 41(6): 774-779.
14. Steunenberg BE, Aerts BAC, Groot HGWD, et al. Is it still necessary to leave a chest tube after video-assisted pulmonary wedge resection? Indian J Thoracic Cardiovasc Surg, 2017, 33(12): 1-5.
15. Ueda K, Hayashi M, Tanaka T, et al. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg, 2013, 44(2): 225-229.
16. Murakami J, Ueda K, Tanaka T, et al. The validation of a no-drain policy after thoracoscopic major lung resection. Ann Thorac Surg, 2017, 104(3): 1005-1011.
17. Yang SM, Wang ML, Hung MH, et al. Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules. Ann Thorac Surg, 2017, 103(2): 462-468.
18. Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
19. 张璐, 李星, 张亚年, 等. 单孔胸腔镜肺楔形切除术后不留置胸腔闭式引流管在快速康复中的应用. 江苏医药, 2018, 44(2): 157-161.
20. 王炯杰, 王新, 王雷, 等. 肺切除后无胸腔引流管适应症的临床研究. 世界肿瘤研究, 2020, 10(3): 59-63.
21. 霍宏健, 杨云龙. 胸腔镜治疗肺部炎性假瘤术后是否置胸管的对比研究. 科技视界, 2015, (33): 293.
22. 曹雄, 韩彪, 马敏杰, 等. 无管化治疗方式在肺大疱切除术中的应用. 中国胸心血管外科临床杂志, 2019, 26(5): 436-439.
23. Lesser T, Doenst T, Lehmann T, et al. Lung bioposy without pleural drainage. Dtsch Arztebl Int, 2019, 116(19): 329-334.
24. Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer, 2017, 17(1): 75.
25. 李庆新, 张宏伟, 晁栋, 等. 单操作孔全胸腔镜在胸部疾病诊断与治疗中的应用. 西北国防医学杂志, 2012, 33(5): 542-544.
26. Klapper J, D'Amico TA. VATS versus open surgery for lung cancer resection: moving toward a minimally invasive approach. J Natl Compr Canc Netw, 2015, 13(2): 162-164.
27. Cheng K, Yuan M, Xu C, et al. A chest tube may not necessary in children thoracoscopic lobectomy. Medicine (Baltimore), 2019, 98(26): e15857.
28. Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin, 2005, 15(1): 105-121.
29. Li P, Shen C, Wu Y, et al. It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: A meta-analysis. J Thorac Dis, 2018, 10(5): 2712-2721.
30. Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and feasibility of no chest tube after thoracoscopic pneumonectomy: A systematic review and meta-analysis

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