Enhanced recovery in lung surgery: coaxial versus conventional chest drains following video-assisted thoracoscopic surgery lobectomy-a prospective randomized trial.

BACKGROUND

Effective chest drainage is essential in thoracic surgery to prevent postoperative complications such as pneumothorax, subcutaneous emphysema, and retained pleural fluid. Although conventional single-lumen chest tubes have been standard practice, their limitations-particularly in the presence of high air leak or bloody effusions-have prompted investigation into more efficient alternatives such as coaxial drains. This study compares the clinical performance of conventional and coaxial drainage systems following video-assisted thoracoscopic surgery (VATS) lobectomy.

METHODS

In a prospective, randomized trial, 300 patients undergoing VATS lobectomy for non-small cell lung cancer were assigned to receive either a 24 F conventional tube (CT) group (n=150) or a 24 F coaxial drain (CD) group (n=150). All drains were connected to a digital suction device. Recorded parameters included air flow, pleural fluid volume, drain occlusion, subcutaneous emphysema, drainage duration, hospital stay, and C-reactive protein (CRP) levels from postoperative day (POD) 1 to 5.

RESULTS

Drainage duration was significantly shorter in the coaxial group (4±2 days) compared with the conventional group (6±3 days, P=0.04). Tube occlusion occurred in 30% of CTs versus 4% of coaxial drains (P=0.02). Subcutaneous emphysema was more frequent in the conventional group (56% vs. 38%, P=0.03). CRP levels were significantly lower in the coaxial group on PODs 3 to 5 (P<0.01). Fluid output thresholds on the operative day (>1,000 mL) and POD 1 (>500 mL) were predictive of prolonged drainage.

CONCLUSIONS

Coaxial chest drains offer superior performance in cases of significant air leakage, reducing complications and postoperative inflammation. Combined with digital drainage systems, they support faster recovery and better compliance with Enhanced Recovery After Surgery (ERAS) protocols. These findings advocate for broader adoption of coaxial drains in thoracic surgical practice.

TRIAL REGISTRATION: Clinical Trial Registry, NCT04778826.