Safety and Efficacy of the Coaxial Drain after Lobectomy: A Randomized Controlled Trial

Background: Pleural drainage is fundamental after lobectomy because it leads to air and fluids removal, avoiding pneumothorax and intrapleural fluids collection. Usually, the drains are left in place since no air leak has been detected and pleural effusion has been less than 300 mL in 24 hours. Recently, a new coaxial tube has been introduced with a combination of an external spiral drain to facilitate fluid and an internal coaxial for air drainage. This prospective randomized trial aims to assess the safety and efficacy of the coaxial chest drain after lobectomy compared with regular silicone-based thoracic drains used for years at our institution.

Method: From 10/2020 to 07/2021, a total of 55 patients undergoing lobectomy were blindly randomized in two groups: coaxial drain in 25 patients (study group); standard drain in 30 patients (control group). This randomized controlled study was approved by the Ethic Committee (protocol number: 19–1668) of our university hospital. All patients received a follow-up including a postoperative checkup and an X-ray in our outpatient clinic 10 days after discharge.

Results: No differences were identified between study and control Group, in terms of postoperative air-leak duration (0.5 ± 1.4 vs. 0.7 ± 1.5 days; p-value = 0.31), postoperative chest tube stay (5.0 ± 2.3 vs. 5.0 ± 2.6 days; p-value = 1.0) and postoperative length of stay (7.3 ± 4.5 vs. 7.5 ± 4.1 days; p-value = 0.85). However, a higher pleural effusion-drained volume was recorded in the study Group on postoperative days 1 and 2 (day one: 617.4 ± 181.4 mL vs. 455.7 ± 190.4 mL; p = 0.002; day two 515.0 ± 200.8 mL vs. 335.0 ± 13,974 mL; p = 0.002). Pleural effusion volume did not differ on the third postoperative days. But the overall effusion volume did also differ significantly between groups (1,811.0 ± 876.3 mL vs. 1,291.3 ± 668.1 mL; p = 0.02). Patients from the study group underwent a left upper lobe resection significantly more often than control group (28.0 vs. 16.7%; p = 0.04). No significant differences were observed in terms of pleural effusion or pneumothorax at the follow-up 10 days after discharge.

Conclusion: In this randomized controlled trial, the new coaxial drain was safe, efficient, and well tolerated by patients undergoing lobectomy, suggesting it could also be used as an alternative to standard drains. But the higher price is not justified. Obviously, there are therapeutic applications where higher pleural effusion drained volume could be beneficial.

Publication History

Article published online:
03 February 2022