Prophylactic air-extraction strategy after thoracoscopic wedge resection

Jia-Tao Zhang, Yi-Chun Tang, Jun-Tao Lin, Song Dong, Qiang Nie, Ben-Yuan Jiang, Hong-Hong Yan, Zheng-Wei Wen, Yue Wu, Xue-Ning Yang, Yi-Long Wu, Wen-Zhao Zhong, Jia-Tao Zhang, Yi-Chun Tang, Jun-Tao Lin, Song Dong, Qiang Nie, Ben-Yuan Jiang, Hong-Hong Yan, Zheng-Wei Wen, Yue Wu, Xue-Ning Yang, Yi-Long Wu, Wen-Zhao Zhong

Abstract

Background: Since the conception of enhanced recovery after surgery protocols, tubeless strategies have become popular. Herein, we introduce a previously unreported alternative air-extraction strategy for patients who have undergone thoracoscopic wedge resection and explore its feasibility and safety.

Methods: Between January 2015 and June 2017, 264 consecutive patients underwent thoracoscopic wedge resection with different drainage strategies. Patients were divided according to the postoperative drainage strategies used: routine chest tube drainage (RT group), complete omission of chest tube drainage (OT group), and prophylactic air-extraction catheter insertion procedure (PC group). Using the propensity score matching method, clinical parameters and objective operative qualities were compared among the three groups.

Results: Optimal 1:1 matching was used to form pairs of RT (n =36) and PC (n =36) groups and balance baseline characteristics among the three groups. The incidence rates of pneumothorax were 5.6% (2/36), 9.8% (5/51), and 19.4% (7/36) in the RT, OT, and PC groups, respectively (P = 0.07). Chest tube reinsertion incidence for postoperative pneumothorax was 19.4% (1/7) in the PC group and 60% (3/5) in the OT group. Other postoperative complications were comparable among these groups.

Conclusions: The prophylactic air-extraction strategy may be an alternative procedure for selected patients. Remedial air extraction may reduce the occurrence of chest tube reinsertion for pneumothorax patients, but further investigation is required.

Keywords: Air-extraction strategy; pneumothorax; thoracoscopic wedge resection; tubeless.

© 2018 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Figures

Figure 1
Figure 1
The core procedure of different drainage strategies. OT, complete omission of chest tube drainage; PC, prophylactic air‐extraction catheter insertion procedure; RT, routine chest tube drainage VATS, video‐assisted thoracoscopic surgery.
Figure 2
Figure 2
The prophylactic air‐extraction strategy procedure. (a) A 1.1 cm mixed ground glass nodule in the right upper lobe; (b) uniportal video‐assisted thoracoscopic surgery (VATS) wedge resection; (c) a puncture into the second intercostal space; (d) preset two‐lumen central venous catheter; (e) gradual inflation of the remaining lung; (f) air‐tightness test when suturing; (g) the incision after suturing; and (h) air‐extraction via injector.
Figure 3
Figure 3
Schematic of the analysis. OT, complete omission of chest tube drainage; PC, prophylactic air‐extraction catheter insertion procedure; PSM, propensity score matching; RT, routine chest tube drainage.
Figure 4
Figure 4
Chest roentgenogram of a patient who underwent air extraction using the prophylactic air‐extraction catheter insertion procedure. Chest roentgenogram on (a) postoperative day 1 shows massive pneumothorax (the red arrow shows the pneumothorax line) and (b) after the remedial air‐extraction strategy.

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Source: PubMed

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