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. 2022 Aug 8:12:915020.
doi: 10.3389/fonc.2022.915020. eCollection 2022.

Comparison of perioperative outcomes with or without routine chest tube drainage after video-assisted thoracoscopic pulmonary resection: A systematic review and meta-analysis

Rongyang Li  1 , Jianhao Qiu  1 , Chenghao Qu  1 , Zheng Ma  1 , Kun Wang  1 , Yu Zhang  1 , Weiming Yue  1 , Hui Tian  1
Affiliations

Comparison of perioperative outcomes with or without routine chest tube drainage after video-assisted thoracoscopic pulmonary resection: A systematic review and meta-analysis

Rongyang Li et al. Front Oncol. .

Abstract

Background: In recent years, an increasing number of thoracic surgeons have attempted to apply no routine chest tube drainage (NT) strategy after thoracoscopic lung resection. However, the safety and feasibility of not routinely placing a chest tube after lung resection remain controversial. This study aimed to investigate the effect of NT strategy after thoracoscopic pulmonary resection on perioperative outcomes.

Methods: A comprehensive literature search of PubMed, Embase, and the Cochrane Library databases until 3 January 2022 was performed to identify the studies that implemented NT strategy after thoracoscopic pulmonary resection. Perioperative outcomes were extracted by 2 reviewers independently and then synthesized using a random-effects model. Risk ratio (RR) and standardized mean difference (SMD) with 95% confidence interval (CI) served as the summary statistics for meta-analysis. Subgroup analysis and sensitivity analysis were subsequently performed.

Results: A total of 12 studies with 1,381 patients were included. The meta-analysis indicated that patients in the NT group had a significantly reduced postoperative length of stay (LOS) (SMD = -0.91; 95% CI: -1.20 to -0.61; P < 0.001) and pain score on postoperative day (POD) 1 (SMD = -0.95; 95% CI: -1.54 to -0.36; P = 0.002), POD 2 (SMD = -0.37; 95% CI: -0.63 to -0.11; P = 0.005), and POD 3 (SMD = -0.39; 95% CI: -0.71 to -0.06; P = 0.02). Further subgroup analysis showed that the difference of postoperative LOS became statistically insignificant in the lobectomy or segmentectomy subgroup (SMD = -0.30; 95% CI: -0.91 to 0.32; P = 0.34). Although the risk of pneumothorax was significantly higher in the NT group (RR = 1.75; 95% CI: 1.14-2.68; P = 0.01), the reintervention rates were comparable between groups (RR = 1.04; 95% CI: 0.48-2.25; P = 0.92). No significant difference was found in pleural effusion, subcutaneous emphysema, operation time, pain score on POD 7, and wound healing satisfactory (all P > 0.05). The sensitivity analysis suggested that the results of the meta-analysis were stabilized.

Conclusions: This meta-analysis suggested that NT strategy is safe and feasible for selected patients scheduled for video-assisted thoracoscopic pulmonary resection.

Systematic review registration: https://inplasy.com/inplasy-2022-4-0026, identifier INPLASY202240026.

Keywords: meta-analysis; no routine chest tube drainage strategy; perioperative outcomes; systematic review; traditional chest tube drainage; video-assisted thoracoscopic lung resection.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of literature retrieval. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Meta-analysis and subgroup analysis of postoperative length of stay (LOS) between the NT and RT groups. (A) Meta-analysis of postoperative LOS; (B) Subgroup analysis of postoperative LOS. NT, no routine chest tube drainage; RT, routine chest tube drainage; CI, confidence interval.
Figure 3
Figure 3
Meta-analysis of postoperative complications between the NT and RT groups. (A) Pneumothorax; (B) Pleural effusion; (C) Subcutaneous emphysema. NT, no routine chest tube drainage; RT, routine chest tube drainage; CI, confidence interval.
Figure 4
Figure 4
Meta-analysis of reintervention rate between the NT and RT groups. NT, no routine chest tube drainage; RT, routine chest tube drainage; CI, confidence interval.
Figure 5
Figure 5
Meta-analysis of postoperative pain score between the NT and RT groups. (A) POD 1; (B) POD 2; (C) POD 3; (D) POD 7. NT, no routine chest tube drainage; RT, routine chest tube drainage; POD, postoperative day; CI, confidence interval.
Figure 6
Figure 6
Meta-analysis of operation duration between the NT and RT groups. NT, no routine chest tube drainage; RT, routine chest tube drainage; CI, confidence interval.
Figure 7
Figure 7
Meta-analysis of wound healing satisfaction between the NT and RT groups. NT, no routine chest tube drainage; RT, routine chest tube drainage; CI, confidence interval.
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