Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis

Abstract Background The optimal sequence of pulmonary vessel interruption during lung cancer resection remains controversial. This review aimed to elucidate the association of vein-first versus artery-first ligation and circulation tumor cells (CTCs) dissemination and survival of the patients. Methods We searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to October 2020 for published articles that compared vein-first (the pulmonary vein was interrupted first) and artery-first procedure (the pulmonary artery was ligated first) during lung cancer surgery. Results Finally, a total of 13 full articles were included. First, 7 of these studies with survival data were included for meta-analysis. As compared with artery-first ligation, vein-first approach did not decrease local recurrence (risk ratio [RR] 0.96 in favour of vein-first ligation; 95% confidence interval [CI] 0.77–1.19, p = 0.68) or distant metastasis (RR 0.93; 95% CI 0.34–2.54, p = 0.89), but it was associated with better 5-year overall survival of the patients (RR 0.72; 95% CI 0.52–0.99, p = 0.04). Second, 7 studies provided the data of tumor cells using different biomarkers and detection methods; thus, a quantitative meta-analysis was not possible. Among them, 3 studies showed that vein-first decreased the extent of tumor dissemination. Conclusion Vein-first ligation in lung cancer surgery is associated with improved survival of the patients and potentially decreased surgery-related tumor dissemination. Further high-quality trials are warranted.

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Gravity Drainage Versus Forced Suction Drainage for Patients With Excess Fluid in Pleural or Peritoneal Spaces

Canadian Journal of Health Technologies ◽

10.51731/cjht..31 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Yan Li ◽

Charlene Argáez

Keyword(s):

Lung Cancer ◽

Hospital Stay ◽

Chest Tube ◽

Meta Analysis ◽

Lung Cancer Surgery ◽

Cancer Surgery ◽

Gravity Drainage ◽

Chest Drainage ◽

Tube Drainage ◽

Randomized Controlled

The evidence for chest drainage with gravity compared with forced suction was mixed. Two randomized controlled trials included in 2 systematic reviews with meta-analysis suggested that there is no difference between chest drainage with gravity versus forced suction regarding the risk of prolonged air leak, or post-operative pneumothorax and the duration of chest tube drainage, or hospital stay, following lung cancer surgery. However, 1 randomized controlled trial included in a systematic review with meta-analysis suggested that chest drainage with gravity resulted in a shorter duration of chest tube drainage and hospital stay compared to forced suction following lung cancer surgery. One guideline suggests that chest drainage with forced suction does not provide additional benefits for patients undergoing lung surgery compared to gravity drainage. There is a lack of relevant literature and guidelines on the clinical effectiveness or use of abdominal space drainage with gravity or forced suction.

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