A Prospective Randomized Control Study About Indication Of Chest Tube Removal Following A VATS Lobectomy

Objective: To study the feasible and safe volume threshold for chest tube removal following a video-assisted thoracoscopic surgery lobectomy.Methods: 168 consecutive patients(18 were excluded) who underwent video-assisted thoracoscopic surgery lobectomy or bilobectomy with two incisions between August 2012 and February 2014 were included. Eligible patients were randomized into three groups: Group A(chest tube was removed at the drainage volume of 150ml/d or less. n=49); Group B(chest tube was removed when the drainage volume was less than 300ml/d. n=50); Group C(chest tube was removed when the drainage was less than 450ml/d. n=51). The postoperative care of all patients was consistent. All patients were followed-up 7 days after discharging from hospital. The time of extracting drainage tube, postoperative hospital stay, postoperative visual analogue scale grades, dosage of analgesic, incidence of complications and thoracocentesis were measured.Result: The pathologic analysis included squamous carcinoma, adenocarcinoma and other types of non-small-cell lung cancer. There were no statistically significant differences among the three groups(p =0.957). The numbers of the resected lymph nodes of Group A, B and C were 11.9±1.3, 12.4±1.2 and 12.6±1.0(p=0.844). There were no significant differences among the three groups in terms of resected lung lobes and(P>0.05). The three groups were comparable in terms of mean age, sex, time of operation and the number of chest tubes used(P>0.05). The patients in Group B and C had a significantly shorter draining time and postoperative hospital stay than Group A(P < 0.05). Compared with Group B, patients in Group C had a significantly shorter draining time(p=0.036). The mean postoperative hospital stay was 4.8±1.1 days in Group B and 4.3±1.2 days in Group C(p=0.066). The mean dosage of pethidine hydrochloride was 248.9±33.3 mg in Group B and 226.1±32.7 mg in Group C(P>0.05). The dosage of pethidine hydrochloride of GroupA(370.5±42.6 mg) was significantly higher than Group B and C(P < 0.05). The total VAS score of five days showed no statistically significant differences between Group B and Group C(P>0.05), but Group A had a significantly higher total VAS score than Group B and C(P < 0.05). There were 13 patients who developed a fluid accumulation, two from Group B and one in need of a thoracentesis. 11 of them were from Group C and 10 needed thoracentesis or the reinsertion of chest tube. The number of patients who needed thoracentesis form Group C was statistically more than Group B and A(P < 0.05). However, there were no statistically significant differences with the number of patients who needed the reinsertion chest tube among the three groups(P>0.05).Conclusion: A 300ml/d volume threshold for chest tube removal after video-assisted thoracoscopic surgery lobectomy is feasible and safe, bringing more advantages than the 150ml/d volume threshold. However, a 450ml/d volume threshold for chest tube removal may increase the risk of thoracentesis, compared to 300ml/d and 150ml/d volume threshold.