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Is it safe not to drain the pneumonectomy space?
Karim Morcos1, Kasra Shaikhrezai, Alan J B Kirk
1Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK.
Interactive Cardiovascular and Thoracic Surgery
|February 1, 2014
Summary
Not draining the pneumonectomy space after surgery appears safe, with low complication rates. While evidence is limited, this approach may be a viable option for managing the postpneumonectomy space.
Area of Science:
- Thoracic Surgery
- Surgical Outcomes
- Evidence-Based Medicine
Background:
- Management of the postpneumonectomy space (PPS) is critical after lung removal surgery.
- Traditional methods involve chest drain placement, but the necessity of this practice is debated.
- Complications such as empyema and bronchopleural fistula are significant concerns in PPS management.
Purpose of the Study:
- To evaluate the safety and efficacy of not placing a chest drain in the pneumonectomy space.
- To synthesize the best available evidence on alternative postpneumonectomy space management strategies.
- To assess complication rates associated with different PPS management approaches.
Main Methods:
- A structured review of 381 identified studies was conducted to find the best evidence.
- Eleven studies were selected for detailed analysis, including expert opinions, small cohorts, and institutional audits.
- Data on complications, outcomes, and alternative PPS management methods were tabulated.
Main Results:
- Major cohorts show very low rates of serious complications (empyema, bronchopleural fistula, mediastinal shift, bleeding) with pneumonectomy.
- A large cohort (408 patients) found low complication rates and suggested PPS drainage is not necessary.
- One study indicated patients with underwater seal drainage may have a higher risk of postpneumonectomy edema.
Conclusions:
- Current evidence suggests that not draining the pneumonectomy space can be performed safely.
- While not definitively superior, the no-drainage approach offers notable simplicity.
- Further large-scale studies are required to definitively compare different PPS management strategies.
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