Pigtail And Chest Tube For Post-operative Robotic Lobectomies
Nicholas MacDonald, Bhupaul ramsuchit.
ORMC, Orlando, FL, USA.
Background: Historically, pulmonary resection has necessitated two chest tubes to augment re-expansion1. Some institutions have transitioned to a single chest tube2. We postulate that this increases post-operative complications and length of stay. This study aims to investigate whether a post-operative pigtail and chest tube offers a better alternative of pleural drainage. Methods: A retrospective analysis of 500 lobectomies was conducted at our institution from 2010 to 2018 after IRB approval. Inclusion criteria included adults who underwent robotic lobectomies for non-small cell lung cancer during the study period. Lobectomies performed for other disease processes, non-anatomic resections, and open resections were excluded. Subjects were categorized whether a single 28 or 24-French chest tube (CT) or one 28 or 24-French chest tube and one 14-French pigtail catheter was utilized (PACT). Statistical analysis was performed using Mann-Whitney U and chi squared tests. Propensityscore matching was utilized for matching. Covariates included age, sex, BMI, prior history, pulmonary function tests, estimated blood loss, and AJCC 8thedition lung cancer staging. Chest tube data and discharge metrics were analyzed. Statistical significance was determined with a p-value of <0.05. Results: A total of 429 patients were identified utilizing the study criteria. Ninety-six patients underwent drainage via single chest tube and 333 patients underwent drainage via a pigtail and chest tube. There was no statistical difference amongst baseline demographic characteristics after adjusting for covariates. Unadjusted and adjusted analysis demonstrated no significant difference in air leak > 5 days, discharge with chest tube, or 30-day readmission between the two groups. However, there was a significant difference in rates of post-operative length of stay between the CT and the PACT group. The mean difference between the CT and PACT was 4.16 and 3.2 days, respectively in the unadjusted group. After adjusting, the mean difference was 4.14 and 3.42 days, respectively. Statistical significance was validated for both unadjusted (p < 0.0001) and adjusted (p = 0.001) groups. Approximately 15.0% (50/333) in the unadjusted and 16.0% (13/81) in the adjusted PACT group received pigtail release for pneumothorax or effusion development. Approximately 6.2% of patients in both the unadjusted (6/96) and adjusted (5/81) groups of the CT required post-operative chest tube placement during their hospital stay. No patients in the PACT group required subsequent chest tube placement during hospitalization. Conclusions: This data is a novel analysis of 28 or 24-French chest tube with a 14-French pigtail catheter for patients undergoing robotic lobectomies for NSCLC. Pigtail catheters inserted intraoperatively reduces the need for additional post-operative procedures and can be used as a reserve for earlier chest tube removal and subsequent discharge. We ascertain that PACT also allows for more judicious pigtail catheter use when inserted at index operation and is a viable alternative to single chest tube for pleural management after lobectomy. Further investigation is warranted to determine effect on post-operative pain and ideal catheter size.
References: 1. Cui, Z., Zhang, Y., Xu, C., Ding, C., Chen, J., Li, C., & Zhao, J. (2019). Comparison of the results of two chest tube managements during an enhanced recovery program after video-assisted thoracoscopic lobectomy: A randomized trial. Thoracic Cancer, 10(10), 1993-1999. images/g39_2.png" target="_blank">
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