The Improved Mediastinal Drainage Strategy for the Enhanced Recovery System After Esophagectomy

Wang, Dengyun; Xu, Liping; Yang, Fulun; Wang, Zongfei; Sun, Haibo; Chen, Xiankai; Xie, Hounai; Li, Yin

doi:10.1016/j.athoracsur.2020.05.188

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…In this study, we used a 19-Fr Blake drain connected to a portable vacuum system. The use of a portable vacuum system connected to the Blake drain is a viable alternative to an underwater seal [ 6 , 12 , 13 ]. A single Blake drain inserted from the right intercostal space into the left thoracic cavity across the mediastinum is useful for the drainage of the left pleural effusion after thoracic esophagectomy [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer: a retrospective study

Hisakura

Ogawa

Akashi

et al. 2022

J Cardiothorac Surg

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Background Mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer occasionally causes postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has been reported to be useful for thoracic esophagectomy; however, its use in mediastinoscope and laparoscope-assisted esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy. Methods This retrospective study included patients who underwent mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer from 2018 to 2021. Transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the abdomen to the left thoracic cavity through the hiatus. We assessed its effectiveness and safety by the daily drainage output, accumulation of postoperative pleural effusion, frequency of postoperative thoracentesis, and other complications. The drainage group comprising 24 patients was compared with the non-drainage group comprising 13 patients, in whom a transhiatal chest drainage tube was not placed during mediastinoscope and laparoscope-assisted esophagectomy. Results The median daily output of the transhiatal chest drainage was 230 mL on day 1, 385 mL on day 2, and 313 mL on day 3. The number of patients with postoperative pleural effusion was significantly reduced from 10/13 (76.9%) in the non-drainage group to 4/24 (16.7%) in the drainage group (p = 0.001). The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.002). There were no significant differences in the occurrence of other postoperative complications. Conclusions Transhiatal chest drainage could evacuate pleural effusion effectively and safely after mediastinoscope and laparoscope-assisted esophagectomy.

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Section: Discussionmentioning

confidence: 99%

Transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer: a retrospective study

Hisakura

Ogawa

Akashi

et al. 2022

J Cardiothorac Surg

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“…The insertion of a chest drainage tube intraoperatively via the intercostal space is di cult in transmediastinal esophagectomy, and in such cases, transhiatal chest drainage is appropriate. Additionally, the use of a portable vacuum system connected to the Blake drain is a viable alternative to the underwater seal [6, 10,11]. A single Blake drain inserted from the right intercostal space into the left thoracic cavity across the mediastinum is useful for drainage of the left pleural effusion after thoracic esophagectomy [12].…”

Section: Discussionmentioning

confidence: 99%

Transhiatal Chest Drainage Reduces The Frequency of Postoperative Thoracentesis In Transmediastinal Esophagectomy For Esophageal Cancer: A Retrospective Study

Hisakura

Ogawa

Akashi

et al. 2021

Preprint

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Background: Transmediastinal esophagectomy for esophageal cancer occasionally results in the postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has reported utility in thoracic esophagectomy; however, its use in transmediastinal esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in transmediastinal esophagectomy.Methods: This retrospective study included patients who underwent transmediastinal esophagectomy for esophageal cancer from 2018 to 2020. The transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the inferior hepatic space to the left thoracic cavity through the hiatus. The drainage group comprising 13 patients was compared with the non-drainage group comprising 13 patients in whom a transhiatal chest drainage tube was not placed during transmediastinal esophagectomy.Results: The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.03). There were no significant differences between the two groups in terms of the occurrence of other postoperative complications, duration of oxygen administration, and postoperative hospital stay.Conclusions: Transhiatal chest drainage could evacuate pleural effusion effectively and safely after transmediastinal esophagectomy. Therefore, this procedure is clinically useful in transmediastinal esophagectomy for esophageal cancer.

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“…Finally, a hand‐sewn, 3‐layer embedded cervical esophagogastric anastomosis was performed 11,17 . Without a chest drainage tube, nasogastric tube, or jejunum nutrition tube, a mediastinal drainage tube (nasal gastrointestinal tube: Ch14, with 25 cm of the tube protruding from the tube hole) was placed in the mediastinum 18 …”

Section: Methodsmentioning

confidence: 99%

Reconstruction of upper mediastinal pleura reduces postoperative complications in enhanced recovery surgery system after esophagectomy: A propensity score matching study

Chen

Xie

et al. 2021

Journal of Surgical Oncology

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Objectives: This study aimed to explore the effect of suturing upper mediastinum pleura on postoperative complications, surgery-related mortality, and hospital stay.Methods: Four hundred and thirty-eight patients with esophageal cancer who underwent esophagectomy were identified. Patients were divided into two groups: those in the test group who received reconstruction of upper mediastinal pleura, those in the conventional group who did not. The incidence of postoperative complications, surgery-related mortality, and hospital stay were compared. To reduce the impact of confounding factors, a propensity score matching (PSM) method was performed.Results: A total of 273 patients were treated with suturing upper mediastinal pleura and 165 were not. After PSM, compared with the conventional group, the incidence of atelectasis (7.2% vs. 1.4%, p = 0.035), anastomotic leakage (5.8% vs. 0.7%, p = 0.036), and delayed gastric emptying (10.8% vs. 3.6%, p = 0.034) were significantly lower in the test group. And suturing the upper mediastinal pleura could reduce the severity of leakage (p = 0.045), consistent with the results before PSM.Moreover, there were no significant differences in the incidence of other complications, postoperative hospital stay, and 30-day mortality (all p > 0.05).Conclusions: In this study, suturing the upper mediastinal pleura can reduce the incidence of atelectasis, anastomotic leakage, and delayed gastric emptying, and the severity of leakage, without increasing the incidence of other complications, surgeryrelated death, and postoperative hospital stay.

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The Improved Mediastinal Drainage Strategy for the Enhanced Recovery System After Esophagectomy

Cited by 9 publications

References 29 publications

Transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer: a retrospective study

Transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer: a retrospective study

Transhiatal Chest Drainage Reduces The Frequency of Postoperative Thoracentesis In Transmediastinal Esophagectomy For Esophageal Cancer: A Retrospective Study

Reconstruction of upper mediastinal pleura reduces postoperative complications in enhanced recovery surgery system after esophagectomy: A propensity score matching study

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