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.
4 affiliations
- 1Department of Thoracic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
- 2Department of Medicine and Surgery, Research Unit of Anatomical Pathology, Università Campus Bio-Medico, Rome, Italy.
- 3Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
- 4Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Abstract
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. 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. 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. 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. The trial was registered on ClinicalTrials.gov (NCT07827885).
Related
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BibTeX
@article{longo2026matter,
title = {{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.}},
author = {Filippo Longo and Antonio Sarubbi and Lorenzo Nibid and Luca Frasca and Ilaria Suriano and Domenico Sarubbi and Alessandra Panichelli and Claudia Palladino and Pierfilippo Crucitti},
journal = {Journal of thoracic disease},
year = {2026},
month = oct,
doi = {10.21037/jtd-2026-1531},
url = {https://europepmc.org/article/MED/42996920},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Filippo Longo
AU - Antonio Sarubbi
AU - Lorenzo Nibid
AU - Luca Frasca
AU - Ilaria Suriano
AU - Domenico Sarubbi
AU - Alessandra Panichelli
AU - Claudia Palladino
AU - Pierfilippo Crucitti
PY - 2026
DA - 2026/10/26
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1531
UR - https://europepmc.org/article/MED/42996920
AB - 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. 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. 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. 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. The trial was registered on ClinicalTrials.gov (NCT07827885).
SN - 2072-1439
SN - 2077-6624
ER -