A Comparison Of Robotic And Video-assisted Lung Resections Based On Different Chest Tube Placement Strategy: A Randomized Controlled Trial

Objective: NSCLC(non-small cell lung cancer)is a common lung cancer with the highest morbidity and mortality among malignant tumors in China.At present,surgery is an effective method for the treatment of early-stage NSCLC.With the development of minimally invasive surgery,RATS(robot-assisted thoracic surgery)and VATS(videoassisted thoracic surgery)are also widely used in the field of thoracic surgery,which can achieve the same effect and prognosis as open surgery,and can reduce surgical trauma and shorten the postoperative hospital stay.Currently,placement of the drainage tube after lung resection is a standard procedure.However,postoperative leakage of pleural fluid and air leakage around the drainage tube incision are common,increasing the likelihood of incision infection and subcutaneous emphysema,which affect the patient’s incision healing.Long-term leakage of pleural fluid also brings inconvenience to the patient’s daily life.Therefore,this study used the separation of the chest drain tube from the intercostal space as a modified chest tube placement strategy to evaluate the safety and efficacy of modified chest tube placement compared with routine chest tube placement in patients undergoing robotic and thoracoscopic surgery.Method: The study included 199 patients who underwent robotic and video-assisted lung resection in the Thoracic Surgery Department of Qingdao University Affiliated Hospital from February 2021 to September 2021.According to different drainage tube placement strategies,the included patients were randomly divided into modified group and routine group.Baseline data such as age,gender,smoking history,lung function,preoperative comorbidities,tumor size,tumor location,pathological type and TNM stage were collected and compared between the two groups.Primary observation indicators included the incidence of leakage of pleural fluid around the drainage tube,the incidence of leakage of pleural fluid after extubation,the incidence of air leakage and the number of dressing changes.Secondary observation indicators included operation time,blood loss,total drainage volume,amount of lymph node dissection,duration of chest tube,postoperative hospital stay,postoperative complications,VAS(visual analogue scale)score and wound Healing satisfaction.Multivariate logistic regression analysis was performed to screen independent factors affecting the severity of incision exudation,and then the surgical effects of VATS and RATS were further compared.Results: A total of 199 patients were randomly assigned to the modified group and the routine group,including 111 women(55.8%)and 88 men(44.2%),with a mean age of58.64±10.46 years.Patients in modified group had a lower incidence of peritubular leakage of pleural fluid(after surgery: 39.6% vs.18.4%,P=0.001;after chest tube removal: 26.7% vs 11.2%,P=0.005),lower incidence of peritubular air leakage(14.9% vs5.1%,P=0.022),fewer dressing changes(5.01±2.30 vs 3.49±0.97,P<0.001)and higher wound healing satisfaction(96.9% vs.89.1%,P=0.031).There were no significant differences between the two groups in terms of operative time,total drainage,intraoperative blood loss and postoperative complications.Multivariate logistic regression analysis showed that age>60 years(OR: 2.291,95%CI: 1.105-4.748,P=0.026),routine chest tube placement(OR: 6.747,95%CI: 3.046-14.946,P < 0.001)and non-wedge resection(OR: 4.772,95%CI: 1.267-17.967,P=0.021)were independent factors for the severity of incision exudation.The patients who underwent lobectomy and segmentectomy were divided into RATS and VATS subgroups.No significant difference was found between the two groups in baseline data.The total number of lymph node dissections in the RATS group was higher than that in the VATS group(lobectomy:14.42±6.16 vs 18.00±6.82,P=0.014;segmentectomy: 11.21±3.29 vs 13.94±2.36,P=0.002).Conclusion: Under the premise of not affecting the drainage effect,the modified chest tube placement method can significantly reduce the incidence of postoperative incision exudation,air leakage,subcutaneous emphysema and other adverse events,which is a safe and feasible method and is worthy of clinical promotion.RATS has more advantages than VATS in lymph node dissection.For patients of different ages and different surgical methods,individualized treatment plans should be developed.