Cancer treatment and research communications · 2026
Long-term oncological safety of chest tube omission after thoracoscopic anatomic lung resection: A propensity score-weighted analysis.
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Murakami Junichi, Tanaka Toshiki, Yoshimine Sota, Shimokawa Mototsugu, Hamano Kimikazu
Аннотация
BACKGROUND: Although omitting chest tubes after lung resection enhances recovery, concerns persist that undrained fluid might promote tumor recurrence. Because the short-term benefits of this no-drain policy are already established, we evaluated whether it compromises long-term oncologic outcomes in non-small cell lung cancer, testing a safety rather than a superiority hypothesis using propensity score analysis.
PATIENTS AND METHODS: We retrospectively reviewed 474 patients undergoing video-assisted thoracoscopic anatomic resection. Patients were categorized into omission (n = 167) and placement (n = 307) groups based on a strict suction-induced air leakage test confirming pneumostasis. Inverse probability weighting, using 11 clinical covariates, was performed to minimize selection bias. The primary endpoints were overall survival and recurrence-free survival; patterns of initial recurrence, specifically pleural dissemination and malignant effusion, were also analyzed.
RESULTS: After weighting, patient characteristics were well balanced. The omission group showed no significant difference in overall survival (hazard ratio, 0.70; P = 0.152) or recurrence-free survival (hazard ratio, 0.85; P = 0.426), and the incidence of pleural recurrence did not differ between groups (P = 0.191). Subgroup analysis revealed significant interactions, with a trend toward higher recurrence in patients with non-adenocarcinoma histology or positive pleural lavage cytology.
CONCLUSIONS: Omitting chest tubes after anatomic lung resection was not associated with compromised long-term survival or increased pleural recurrence in the overall cohort. Because the study was retrospective and not powered as a formal non-inferiority trial, these findings indicate the absence of a detectable oncologic-safety signal rather than proof of equivalence, and require prospective validation.
PATIENTS AND METHODS: We retrospectively reviewed 474 patients undergoing video-assisted thoracoscopic anatomic resection. Patients were categorized into omission (n = 167) and placement (n = 307) groups based on a strict suction-induced air leakage test confirming pneumostasis. Inverse probability weighting, using 11 clinical covariates, was performed to minimize selection bias. The primary endpoints were overall survival and recurrence-free survival; patterns of initial recurrence, specifically pleural dissemination and malignant effusion, were also analyzed.
RESULTS: After weighting, patient characteristics were well balanced. The omission group showed no significant difference in overall survival (hazard ratio, 0.70; P = 0.152) or recurrence-free survival (hazard ratio, 0.85; P = 0.426), and the incidence of pleural recurrence did not differ between groups (P = 0.191). Subgroup analysis revealed significant interactions, with a trend toward higher recurrence in patients with non-adenocarcinoma histology or positive pleural lavage cytology.
CONCLUSIONS: Omitting chest tubes after anatomic lung resection was not associated with compromised long-term survival or increased pleural recurrence in the overall cohort. Because the study was retrospective and not powered as a formal non-inferiority trial, these findings indicate the absence of a detectable oncologic-safety signal rather than proof of equivalence, and require prospective validation.