A matter of size: 20-Fr vs. 24-Fr chest drainage after uniportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer—a randomized trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Background: Chest drains are routinely used after pulmonary lobectomy to evacuate air and pleural fluid and promote lung re-expansion. However, the optimal chest tube caliber remains controversial, particularly in the context of minimally invasive surgery. Smaller-bore drains may reduce discomfort, whereas larger drains may provide more effective evacuation of air and fluid. The aim of this study was to compare 20-Fr and 24-Fr chest tubes after uniportal video-assisted thoracoscopic surgery (uVATS) lobectomy for non-small cell lung cancer (NSCLC), with particular focus on postoperative pain, pleural drainage-related outcomes, and recovery.Methods: This single-center prospective randomized study included 80 patients undergoing uVATS lobectomy for NSCLC, who were allocated 1:1 to receive either a 20-Fr or 24-Fr chest tube (n=40 per group). The primary outcome was postoperative pain at 24 hours, assessed using the Numeric Rating Scale (NRS). Secondary outcomes included NRS pain at 12 and 48 hours, prolonged air leak (PAL), chest tube duration, subcutaneous emphysema, analgesic requirements, respiratory physiokinesitherapy outcomes, and length of stay (LOS). Pneumothorax (PNX) and pleural effusion (PE) were evaluated as exploratory radiographic outcomes.Results: The 24-Fr group showed significantly lower rates of PNX on postoperative day (POD) 3 (27.5% vs. 60.0%, P=0.003) and PE on POD2 (50.0% vs. 77.5%, P=0.01). Conversely, patients with 24-Fr drains reported significantly higher NRS pain scores at 12 hours [4.0 (3.0–5.0) vs. 2.0 (2.0–4.0), P=0.001], 24 hours [5.0 (4.0–6.0) vs. 4.0 (3.0–5.0), P=0.002], and 48 hours [5.5 (4.8–6.2) vs. 4.5 (3.0–6.0), P=0.02]. No significant differences were observed in PAL (27.5% vs. 47.5%, P=0.07), chest tube duration, subcutaneous emphysema, analgesic requirements, or LOS.Conclusions: After uVATS lobectomy, 24-Fr chest tubes were associated with better early radiographic pleural control but greater postoperative pain. These findings highlight a trade-off between drainage efficiency and patient comfort and support an individualized approach to chest tube selection.Trial Registration: The trial was registered on ClinicalTrials.gov (NCT07827885).
Source: Journal of Thoracic Disease
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224099344