Feasibility of uniportal thoracoscopic sublobar resection without chest tube drainage: a retrospective cohort study.

BACKGROUND

Tubeless strategy of thoracoscopic surgery has become a new topic in recent years. This study aimed to investigate the feasibility of no chest tube drainage compared with chest tube drainage in patients who underwent uniportal thoracoscopic sublobar resection.

METHODS

Patients who underwent uniportal thoracoscopic sublobar resection with or without chest tube drainage were included in this retrospective cohort study. They were required to have a negative intraoperative air leakage test. Data regarding perioperative outcomes, postoperative complications, postoperative pain visual analogue scale (VAS) score at rest, and patients' satisfaction were collected.

RESULTS

A total of 60 patients without chest tube drainage served as the tubeless group, while another 60 age/sex-matched patients with chest tube drainage served as the chest tube group. Pneumothorax occurred in only one (1.7%) patient in the tubeless group, which was not significantly different from 0 (0.0%) patient in the chest tube group (P = 0.500). This patient was further readmitted and underwent conversion to chest tube drainage. No patient experienced other postoperative complications such as pleural effusion and pulmonary infection in either group. The operational time (P < 0.001), perioperative blood loss (P = 0.007), total hospital stay (P = 0.001), and postoperative hospital stay (P < 0.001) were lower in the tubeless group than in the chest tube group. The pain VAS score was decreased in the tubeless group compared with the chest tube group on postoperative day (POD) 1 (P = 0.003) and 2 (P = 0.020), but not changed on POD 3 (P = 0.200). Moreover, patients' satisfaction scale (P = 0.410) and overall satisfaction rate (P = 0.375) were not different between the two groups. After adjustment using multivariable regressions, tubeless versus chest tube was independently correlated with a lower operational time (P < 0.001), total hospital stay (P = 0.003), postoperative hospital stay (P < 0.001), and pain VAS score on POD1 (P = 0.009) and POD2 (P = 0.042) but was not independently associated with perioperative blood loss (P = 0.110), pain VAS score on POD3 (P = 0.348), pneumothorax presence (P = 0.997), or overall satisfaction (P = 0.553).

CONCLUSION

Uniportal thoracoscopic sublobar resection without chest tube drainage may be feasible in the selected, low-risk patients without intraoperative air leakage. However, further prospective studies with standardized outcome capture are still needed for validations.