Postoperative pulmonary complications and thoracocentesis associated with early versus late chest tube removal after thoracic esophagectomy with three-field dissection: a propensity score matching analysis.

Sato, Takuji; Fujita, Takeo; Okada, Naoya; Fujiwara, Hisashi; Kojima, Takashi; Hayashi, Ryuichi; Daiko, Hiroyuki

PURPOSE To evaluate the safety of early chest tube removal after thoracic esophagectomy with three-field dissection. METHODS This prospective cohort study evaluated patients who underwent thoracic esophagectomy with three-field dissection during 2013-2015. Patients were divided into two groups according to whether they underwent early or late chest tube removal. Propensity score matching in a 1:1 ratio was applied. We compared the incidences of postoperative pulmonary complications and thoracocentesis in the two groups. RESULTS After propensity score matching, 89 patients in each group were analyzed. There was no significant difference between the groups in the incidences of pulmonary complications or thoracocentesis. Significantly more patients achieved first mobilization within 15 h postoperatively in the early removal group (89.8%) than in the late removal group (52%, p < 0.01). Multivariate analysis revealed that early chest tube removal was not a risk factor for pulmonary complications or thoracocentesis. Independent risk factors for pulmonary complications were a history of pulmonary disease (odds ratio: 0.81 [0.63-0.98]; p = 0.02) and neoadjuvant chemotherapy (odds ratio: 0.67 [0.32-0.96]; p = 0.04). CONCLUSION Early chest tube removal is as safe and feasible as late chest tube removal after thoracic esophagectomy with three-field dissection.