Lung Bioposy Without Pleural Drainage

Abstract

Background: Video-assisted thoracoscopy and atypical resection of lung parenchyma is a surgical procedure that is carried out very commonly around the world, mainly to determine the degree of malignancy of a suspect pulmonary nodule. A pleural drain is routinely inserted at the end of the procedure. The goal of our study was to evaluate the outcomes of this procedure with and without pleural drainage.

Methods: From June 2015 to January 2018, 74 patients were prospectively randomized to either the chest-tube group (CT group, 37 patients) or the no-chest-tube group (NCT group, 37 patients) and were followed up until the seventh day after surgery. The postoperative duration of hospital stay was the primary endpoint; the secondary endpoints were the rates of pneumothorax and repeated chest drainage, pain intensity, and analgesic consumption. Blinding was not possible. An intention- to-treat analysis was performed. (Study registration; DRKS00008194, www.drks.de/drks.).

Results: Hospital stays were significantly shorter in the NCT group (means and first and fourth quartiles: 1.5 [1.5; 1.5] versus 2.5 [2.5, 2.5] days, p<0.001). The two groups did not differ significantly with respect to the frequency of postoperative complications. There were two occurrences of postoperative pneumothorax in the NCT group, with one patient needing drainage via chest tube and the other needing no treatment. Pain intensity and analgesic consumption were markedly lower in the NCT group; the cumulative oral intake of metamizole and acetaminophen was also lower in the NCT group (mean ± standard deviation: 3.7 ± 2.2 g in the NCT group versus 10.0 ± 4.2 g in the CT group, p<0.001).

Conclusion: Not inserting a chest tube after video-assisted thoracoscopic lung biopsy significantly shortens the postoperative hospital stay, and the complications in the chest-tube and no-chest-tube groups are similar. Postoperative pain and analgesic consumption are markedly less when no chest tube is inserted.

Figures

Figure 1

Videothoracoscopic view of an atypical lung parenchymal resection (linear resection) with an endostapler, on the partially collapsed, non-ventilated lung

Figure 2

Flow chart CT, chest tube; NCT, non–chest tube

Figure 3

Frequency of length of postoperative hospital stay for both groups CT, chest tube; NCT, non–chest tube

Figure 4

Postoperative pain intensity for both groups (according to NRS) measured daily (mornings, noon, and evenings) until POD 7 (mean ± SD; p

Figure 5

Postoperative consumption of the analgesics metamizole or paracetamol (in grams) for both groups (mean ± SD; p