Discussion
pleural effusion, postoperative pain, oesophageal cancer
PLEURAL EFFUSION, SECONDARY, OESOPHAGEAL CANCER, PERIOPERATIVE COMPLICATION
In the past, the removal of chest drains after oesophageal resections were often determined by the daily amount of secretion. For many surgeons, a daily secretion of less than 200 ml in 24 h represented a cut-off value from which drainage could be safely removed. However, these values were based on prevailing doctrine and the concern of having to reinsert a chest drain rather than on a well-founded scientific data [Enhanced recovery after surgery (ERAS) protocols after oesophagectomy can additionally lower morbidity but still include thoracic chest drains for a minimum of a week after the operation. Reduction in the number and early removal of chest drains has already been advocated after pulmonary resections.The current data show that more aggressive chest drain removal strategies under ERAS programmes are safe and feasible. For example, a threshold of 500 ml per 24 h led to recurrent pleural effusion after video-assisted thoracic surgery in only 2.8% of patients [Regarding the number of chest drains, several studies have shown that the insertion of two chest tubes is not superior to the insertion of a single chest tube after pulmonary lobectomy. The use of one chest tube is more effective than the use of two tubes because it causes less postoperative pain, less pleural effusion, and reduced chest tube duration without affecting postoperative morbidity [There are no reports of randomized controlled trials investigating the potential advantages of modern RAMIE for oesophageal cancer without postoperative abdominal and chest drains compared to the postoperative use of chest drains, which is considered standard practice worldwide. This randomized controlled multicentric trial was therefore initiated to assess whether avoidance of chest drains during the postoperative course after RAMIE can significantly reduce postoperative pain, improve functional recovery, and shorten hospital stay compared to the use of chest drains. Avoidance of chest drains during the postoperative course is achieved by the removal of a chest drain 3 h after the end of the surgical procedure. The current standard in consensus fast-track protocols after oesophagectomy is the removal of chest tubes on POD 6 [This study aims to compare two different chest drain management strategies in patients undergoing RAMIE for oesophageal cancer with regard to perioperative complications until discharge. The study’s primary objective is to investigate whether the intensity of postoperative pain can be significantly reduced by avoiding thoracic drains after RAMIE. We assume that this will influence secondary endpoints such as early recovery and length of hospital stay.