Autologous blood pleurodesis for the treatment of postoperative air leaks. A systematic review and meta-analysis

Abstract Background Postoperative air leaks are a common complication after lung surgery. They are associated with prolonged hospital stay, increased postoperative pain and treatment costs. The treatment of prolonged air leaks remains controversial. Several treatments have been proposed including different types of sealants, chemical pleurodesis, or early surgical intervention. The aim of this review was to analyze the impact of autologous blood pleurodesis in a systematic way. Methods A systematic review of the literature was conducted until July 2020. Studies with more than five adult patients undergoing lung resections were included. Studies in patients receiving blood pleurodesis for pneumothorax were excluded. The search strategy included proper combinations of the MeSH terms “air leak”, “blood transfusion” and “lung surgery”. Results Ten studies with a total of 198 patients were included in the analysis. The pooled success rate for sealing the air leak within 48 h of the blood pleurodesis was 83.7% (95% CI: 75.7; 90.3). The pooled incidence of the post‐interventional empyema was 1.5%, with a pooled incidence of post‐interventional fever of 8.6%. Conclusions Current evidence supports the idea that autologous blood pleurodesis leads to a faster healing of postoperative air leaks than conservative treatment. The complication rate is very low. Formal recommendations on how to perform the procedure are not possible with the current evidence. A randomized controlled trial in the modern era is necessary to confirm the benefits

Uniportal VATS Fissureless Resection of the Anterior Segment of the Right Upper Lobe

<div>A 79-year-old female patient was admitted to the author’s clinic for the treatment of a solitary tumorous formation, which appeared to be a metachronous metastatic tumor of a colon carcinoma located in the anterior segment of the right upper lobe.</div><div><p>Due to enlarged mediastinal lymph nodes, the patient underwent an endobronchial ultrasound prior to surgery. Since the results were favorable, surgery was offered. An anatomical anterior segment resection of the upper right lobe was conducted, followed by radical lymph node dissection. The patient’s postoperative course was uneventful, and she was discharged on the fourth postoperative day.</p><p>Pathologic investigation revealed that the lymph nodes at the second and fourth stations had metastasis, but without extranodal growth. The patient had already been treated with diverse chemotherapy, therefore radiotherapy was offered as she was under elevated risk for a local recurrence.  </p></div

Uniportal VATS Resection of the Anterior Segment of the Left Upper Lobe

<p>Anterior segment resection of the left upper lobe is rarely performed. It is, however, usually incorporated within resection of the upper three segments of the left upper lobe.<br></p><p>A 56-year-old patient, with a known oropharyngeal carcinoma and otherwise amenable to curative treatment, was admitted to the authors’ clinic for a 1 cm nodule in the anterior segment of the left upper lobe. Distant metastases were excluded, and a decision was made to proceed with uniportal video-assisted thoracoscopic surgery to perform a segmentectomy and lymphadenectomy. An anatomical anterior segment resection of the upper left lobe was conducted, followed by radical lymph node dissection.</p><p>The patient’s postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Pathologic investigation revealed that the tumor was a primary solid 1 cm adenocarcinoma, and the final stage was pT1aN0M0.</p

A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study

Background!#!The pleural space can resorb 0.11-0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR-specifically 5 ml/kg, a simple, easily applicable measure.!##!Methods!#!This is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day.!##!Results!#!The groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p &amp;lt; 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group).!##!Conclusion!#!The new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252)

A randomized controlled trial: Comparison of 14 and 24 French thoracic drainage after minimally invasive lobectomy – MZ 14-24 study

Background: The optimal placement of a chest drain after video-assisted minimally invasive lobectomy should facilitate the aspiration of air and drainage of fluid. Typically, a conventional 24Ch polyvinyl chloride chest drain is used for this purpose. However, there is currently no scientific literature available on the impact of drain diameter on postoperative outcomes following anatomical lung resection. Methods: This is a prospective, randomized, phase-1 trial that will include 40 patients, which will be randomly assigned into two groups. Group 1 will receive a 24 French chest drain according to current standards, while group 2 will receive a 14 French drain. Primary endpoint of the trial is the incidence of postoperative drainage-related complications, such as obstruction, dislocation, pleural effusion, and reintervention. Secondary endpoints are postoperative pain, chest drainage duration, incidence of complications, and hospital length of stay. The study aims to determine the number of subjects needed to achieve a sufficient test power of 0.8 for a non-inferiority study. Discussion: Thoracic surgery is becoming more and more minimally invasive. One of the remaining unresolved problems is postoperative pain, with the intercostal drain being one of the main contributing factors. Previous data from other studies suggest that the use of small-bore drains can reduce pain and speed up recovery without an increase in drain-related complications. However, no studies have been conducted on patients undergoing anatomic lung resections to date. The initial step in transitioning from larger to smaller drains is to establish the safety of this approach, which is the primary objective of this trial.Trial registration: The study has been registered in the German Clinical Trials Register.Registration number: DRKS00029982.URL: https://drks.de/search/de/trial/DRKS00029982