Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung

Abstract

The aim of the present study was to assess the feasibility and safety of several improved criteria to avoid chest tube placement after thoracoscopic wedge resection of the lung. From 2000 to 2009, 333 patients who underwent thoracoscopic wedge resections of the lung were reviewed. The patients were classified into two groups: (1) the no chest tube group (NCT), consisting of 132 patients in whom chest tubes were not placed because no air leakage or bleeding during intraoperative alternative sealing test was confirmed, and (2) the chest tube placement (CTP) group, consisting of 201 patients in whom chest tubes were placed because the criteria for the nonplacement of a chest tube were not met. The clinical data and postoperative morbidity were assessed between the two groups. The number of specimens (1.3 vs 1.5) and the endostapler cartridges used (2.5 vs 3.3), and the duration of the postoperative hospital stay (4.6 vs 6.7 days) in the NCT group were significantly lower than in the CTP group. One patient from the NCT group required chest tube insertion due to the development of late pneumothorax. However, no significant differences were found between the two groups. Our improved criteria are therefore considered to positively contribute to a safe and definite clinical decision regarding postoperative patient management.