Abstract
BACKGROUND: To access the feasibility and safety of no chest tube (NCT) placement after thoracoscopic pulmonary resection. METHODS: A comprehensive search of online databases (PubMed, Embase, Web of Science, and Cochrane library) was performed. Studies investigating the safety and feasibility of NCT compared with chest tube placement (CTP) after VATS pulmonary resection were eligible for our meta-analysis. Perioperative outcomes were extracted and synthesized. Specific subgroups (wedge resection) were examined. The methodological quality of the included articles was evaluated with the methodological index for non-randomized studies (MINORS) tool. RESULTS: Analysis of 9 studies including a total of 918 patients was performed. Four hundred sixty-one patients underwent NCT and 457 patients underwent CTP. The length of stay (LOS) postoperatively in the NCT group was significant shorter than in the CTP group [standardized mean difference (SMD) = -0.80; 95% confidence interval (CI), -1.13 to -0.47, P=0.000]. Patients in the NCT group experienced slighter pain than patients in the CTP group in postoperative day (POD) one (SMD = -0.41; 95% CI, -0.75 to -0.07, P=0.02), and POD two (SMD = -0.41; 95% CI, -0.75 to -0.07, P=0.02). While, there was no significant difference about the 30-day morbidity for patients who underwent NCT and CTP [relative ratio (RR) =1.01; 95% CI, 0.59-1.74, P=0.04) and the rate of re-intervention (RR =0.89; 95% CI, 0.33-2.40, P=0.57). No perioperative mortality was observed in both groups. The sensitivity analysis suggested that the relative effects between 2 groups have already stabilized. Subgroup analysis revealed an effect modification by operation approach regarding perioperative morbidity, but not for LOS. CONCLUSIONS: This meta-analysis conforms that it is feasible and safe to omit chest tube after thoracoscopic pulmonary resection for patients carefully selected. Randomized controlled trails (RCTs) are urgently needed to verify this conclusion.