Eckert F, Merboth F, Giehl-Brown E, Hasanovic J, Müssle B, Plodeck V, Richter T, Welsch T, Kahlert C, Fritzmann J, Distler M, Weitz J, Kirchberg J
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany.
Front Surg. 2023 Jul 14;10:1213404. doi: 10.3389/fsurg.2023.1213404. eCollection 2023.
Chest drain management has a significant influence on postoperative recovery after robot-assisted minimally invasive esophagectomy (RAMIE). The use of chest drains increases postoperative pain by irritating intercostal nerves and hinders patients from early postoperative mobilization and recovery. To our knowledge, no study has investigated the use of two vs. one intercostal chest drains after RAMIE.
This retrospective cohort study evaluated patients undergoing elective RAMIE with gastric conduit pull-up and intrathoracic anastomosis. Patients were divided into two groups according to placement of one (11/2020-08/2022) or two (08/2018-11/2020) chest drains. Propensity score matching was performed in a 1:1 ratio, and the incidences of overall and pulmonary complications, drainage-associated re-interventions, radiological diagnostics, analgesic use, and length of hospital stay were compared between single drain and double drain groups.
During the study period, 194 patients underwent RAMIE. Twenty-two patients were included after propensity score matching in the single and double chest drain group, respectively. Time until removal of the last chest drain [postoperative day (POD) 6.7 ± 4.4 vs. POD 9.4 ± 2.7, = 0.004] and intensive care unit stay (4.2 ± 5.1 days vs. 5.3 ± 3.5 days, = 0.01) were significantly shorter in the single drain group. Overall and pulmonary complications, drainage-associated events, re-interventions, number of diagnostic imaging, analgesic use, and length of hospital stay were comparable between both groups.
This study is the first to demonstrate the safety of single intercostal chest drain use and, at least, non-inferiority to double chest drains in terms of perioperative complications after RAMIE.
胸腔引流管理对机器人辅助微创食管切除术（RAMIE）后的术后恢复有重大影响。胸腔引流的使用会刺激肋间神经，增加术后疼痛，并阻碍患者术后早期活动和恢复。据我们所知，尚无研究探讨RAMIE术后使用一根与两根肋间胸腔引流管的情况。
这项回顾性队列研究评估了接受择期RAMIE并采用胃管道上提和胸内吻合术的患者。根据放置一根（2020年11月至2022年8月）或两根（2018年8月至2020年11月）胸腔引流管将患者分为两组。以1:1的比例进行倾向评分匹配，并比较单引流组和双引流组的总体和肺部并发症发生率、与引流相关的再次干预、放射学诊断、镇痛药物使用情况以及住院时间。
在研究期间，194例患者接受了RAMIE。倾向评分匹配后，单胸腔引流组和双胸腔引流组分别纳入22例患者。单引流组最后一根胸腔引流管拔除时间[术后第（POD）6.7±4.4天 vs. POD 9.4±2.7天，P = 0.004]和重症监护病房住院时间（4.2±5.1天 vs. 5.3±3.5天，P = 0.01）明显更短。两组之间的总体和肺部并发症、与引流相关的事件、再次干预、诊断性影像学检查次数、镇痛药物使用情况以及住院时间相当。
本研究首次证明了单肋间胸腔引流使用的安全性，并且在RAMIE术后围手术期并发症方面至少不劣于双胸腔引流。
