Chest drainage insights

Optimising Minimally Invasive Thoracic Surgery with Thopaz⁺: Insights from Japanese ERAS Protocols

Time to read: 2 min.

Thopaz⁺ can be universally applied, even for pneumonectomy patients

Summary

After giving an overview of the evolution of lung resection surgery in the era of minimally invasive techniques and ERAS, Dr. Suzuki presented key findings from several recent investigations related to optimization of perioperative care. One area of focus was the prognostic significance of preoperative exercise tolerance in patients with early-stage NSCLC.¹ Out of 862 consecutive patients with pathological stage 0 to I lung cancer, the 673 patients (78.1%) who were able to complete, unassisted, an exercise load of 7 metabolic equivalents of task exercise for 3 minutes had significantly better 5-year survival than those who could not (HR: 3.90; P < 0.001). Notably, exercise-tolerant patients aged 70 years or older had a better prognosis than younger patients without exercise tolerance.

Using Digital Drainage Data for Clinical Decision-Making

Dr. Suzuki then discussed efforts to harness data from digital drain systems to inform decisions regarding early chest drain removal for enhanced recovery after lung resection.² A study published by his group in 2017 showed that longitudinal observation of air flow and pleural pressure patterns allowed clinicians to distinguish between patients with no air leak, de novo postoperative leak, leak exacerbations, leak resolutions, and air leaks without trend toward improvement. Information on the disappearance of an air leak could serve as a signal that the patient was ready for chest tube removal.

Removing the Fluid Threshold Barrier

He also reviewed the results of a multicenter RCT comparing outcomes when chest tubes were removed on postoperative day 2 without regard to drainage volume, versus when chest tubes remained indwelling until drainage volume was less than 300 mL/day.³ Patients in the timed removal group experienced fewer respiratory-related adverse events with similar hospital LOS, median 1 day shorter chest tube duration, and no elevated signals for safety or lung function.

References

1. Fukui M, Matsunaga T, Hattori A et al. Prognostic significance of preoperative exercise tolerance in patients with early-stage lung cancer. J Thorac Cardiovasc Surg. 2024; S0022-5223(24)00006. doi: 10.1016/j.jtcvs.2023.12.026

2. Takamochi K, Imashimizu K, Fukui M et al. Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System. Ann Thorac Surg. 2017; 104: 275-283. doi: 10.1016/j.athoracsur.2017.01.061

3. Takamochi K, Haruki T, Oh S et al. Early chest tube removal regardless of drainage volume after anatomic pulmonary resection: A multicenter, randomized, controlled trial. The Journal of Thoracic and Cardiovascular Surgery. 2023; In press. http://dx.doi.org/10.1016/j.jtcvs.2023.10.050: doi: 10.1016/j.jtcvs.2023.10.050