Chest drain through utility vs separate incision in single-port video-assisted thoracoscopic lobectomy: a randomized controlled trial.

Background: This study explores whether using a separate incision for pleural drainage will yield superior results compared to inserting a chest drain through the utility incision in patients with operable lung cancer undergoing single utility port video-assisted thoracoscopic lobectomy.

Research question: Which one is the best?! Inserting the drain through the utility incision or separate incision in a single utility port video-assisted thoracoscopic lobectomy for lung cancer.

Materials and methods: This was a randomized, open-label, superiority trial including patients with bronchogenic carcinoma who underwent a single utility port video-assisted thoracoscopic lobectomy over a 32-month period. The primary outcome was wound infections and postoperative pain, while the secondary outcomes were the duration of hospitalization and return to work.

Results: The study included 89 patients, and 80 patients completed the trial. The mean age was 65.35 ± 9.47 years, 64 (80%) patients were male, and 69 (86.25%) patients had a 0 ECOG score. Eleven patients (13.75%) had a score of 1. The majority of the patients (35%) were in stage IIIA. There was a small but statistically significant difference in return to work when comparing group A with group B (34 ± 6 vs 31 ± 4 days, P = 0.038). More important were the differences in patients with wound discharge (29 vs 4; P < 0.001) and especially the need for intravenous antibiotic treatment (12 vs 1; P < 0.002). There was only a minimal trend for a decrease in the duration of hospitalization. There was no significant difference in postoperative pain scores.

Conclusions: Inserting the chest drain through a separate incision has superior results compared to inserting it through the utility incision in patients with operable lung cancer undergoing single-port video-assisted thoracoscopic lobectomy. However, more studies with a larger sample size are necessary to confirm these results.

Clinical trial registration: The research was registered in the Research Registry. The registration number is researchregistry8426. The link is https://www.researchregistry.com/register-now#home/?view_2_search=researchregistry8426&view_2_page=1.