A Novel Drainage Strategy Using Chest Tube Plus Pleural Catheter in Uniportal Upper Lobectomy: A Randomized Study

Abstract Objective: We aims to explored whether one pleural catheter plus single chest tube drainage, may achieve a non-inferior drainage effect when compared to the traditional two chest tubes in uniportal video-assisted thoracoscopic surgery (VATS) for an upper pulmonary lobectomy. Methods: Patients that underwent an upper pulmonary lobectomy from January to November 2020 were enrolled in this single-center, randomized, open-label, non-inferiority trial. Prior to closure, patients randomized to an intervention group received an improved drainage strategy involving one pleural catheter with one chest tube (24Fr), while traditional double-chest-tube drainage was applied for the control group. Results: A total of 390 patients entered the study, though 190 were excluded for changing non-uniportal surgical approaches or opting for non-lobectomy resections. Finally, 200 patients were randomized (100 in intervention group and 100 in control group). The baseline demographic and clinical characteristics were comparable between the groups. The incidence of pneumothorax in the intervention and control groups was similar on postoperative day 1 (non-inferiority, 10% vs. 13%, P = 0.658). In addition, there were no significant differences in secondary outcomes like incidence of pneumothorax by day 30, postoperative chest tube/pleural catheter removal time, amount of drainage on day 1, total amount of drainage after operation, or postoperative hospitalization. A significantly lower pain score was observed in the intervention group (3.33±0.68 vs. 3.68±0.94, P = 0.003).Conclusions: The new strategy is non-inferior to double-chest-tube drainage after an upper pulmonary lobectomy, offers superior pain control, and is recommended for an upper lobectomy by uniportal VATS. Trial registration: ClinicalTrials.gov Identifier: NCT04461652, 8th /07/2020.