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P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
P2.17-11 - Impact of Quantitatively Assessed Emphysema on Chest Tube Drainage After Lobectomy for Non-Small Cell Lung Cancer (ID 12251)
16:45 - 18:00 | Author(s): Krzysztof Bederski
After pulmonary resections, one or two chest tubes are used, and the choice is based mainly on local habits rather than on evidence. The aim of the study was to evaluate the impact of quantitatively assessed emphysema on chest drainage using one or two tubes in patients with non-small cell lung cancer (NSCLC).a9ded1e5ce5d75814730bb4caaf49419 Method
Single-centre, prospective randomized trial including patients who underwent lobectomy for NSCLC between February 2016 and December 2017. At the end of the operation, patients were randomized in a 1:1 ratio to the single tube group or to the two tubes group. On the day of surgery, controlled suction of -20 cm H2O was used, switched on the 1st postoperative day to -8 cm H2O. Amount and duration of air leak, chest tube output and differential pleural pressure were recorded using digital chest drainage system. Prolonged air leak was defined as leak lasting >72 h. Chest tubes were removed in the absence of air leak for more than 24 hours, and the chest tube output <250 mL/day. Quantitative analysis of emphysema was performed using the syngo CT. 3D Pulmo software.4c3880bb027f159e801041b1021e88e8 Result
There were 160 patients enrolled, including 100 men, mean age 65.15 years (range: 32-83) and 60 women, mean age 64.58 years (range: 24-81). One chest tube was used in 82 patients, including 52 cases of VATS lobectomy and 108 cases of open lobectomy. Two chest tubes were used in 78 patients, including 22 patients after VATS lobectomy and 56 after open lobectomy. Quantitative assessment of emphysema was performed in a CT study in 160 patients via an assessment evaluation index.
In the single chest tube group there was significantly less air leak in first six hours (124.26 vs. 257.1mL/min; p = 0.01),volume of chest tube output (241.08 vs 345.82 mL; p = 0.000015), and differential in first six hours pleural pressure (2.55 vs 3.14 cm H20); p = 0.041.
Multivariate regression analysis has shown significant effect of lung volume (dV) (p = 0.007) and mean lung density (dMLD) (p = 0.012) for prolonged air leak in the single chest tube group. In two chest tube group, a significant impact of lung volume (p = 0.002) on the volume of chest tube output was found.
Emphysema and lung volume affect the prolonged air leak following lung resection.
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