Long-term oncological safety of chest tube omission after thoracoscopic anatomic lung resection: A propensity score-weighted analysis.

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.