A Network Meta-Analysis of Drainage Systems and Suction Strategies After Lung Cancer Surgery

Optimizing chest drainage management after lung cancer surgery plays a pivotal role in minimizing drainage time and shortening length of hospital stay (LOHS). Currently, a universally acceptable standard is lacking, and a wide range of drain management strategies are practiced. Therefore, the aim of this systematic review and network meta-analysis (NMA) was to determine an optimal chest drain management strategy following anatomical lung resection on drainage duration, LOHS, and complications, while maintaining patient safety.

A systematic search was conducted in PubMed, Embase, ClinicalTrials.gov, and Cochrane Library; last search December 2025. Studies were included if they investigated drain management following anatomical lung resection and reported at least one of the following outcomes: drain duration, LOHS, or complications. Network meta-analysis were performed to integrate both direct and indirect comparisons to identify the optimal drain management strategy.

Seventeen studies (2004-2023), encompassing 2929 patients, were included in the NMA. Eight distinct drainage strategies were identified based on digital or analogue drainage system, and types of suction: continuous, short-term, alternating suction, or water-seal. In general, digital drainage with alternating suction tended to be associated with shorter drainage duration and LOHS when compared with other drainage strategies. Major complications (Clavien-Dindo ≥3) were reported in 13 studies, varying from 0% to 21%.

Digital drainage systems may reduce drainage duration and LOHS compared with analogue systems. Continuous suction appears less effective than water seal or alternating suction. Due to heterogeneity, firm conclusions are limited and should be interpreted with utmost caution, highlighting the need for standardized high-quality studies.