Short summary

Autologous blood pleurodesis is a treatment option in patients with postoperative air leakage, but the current evidence is outdated and up-to-date evidence is needed to clarify the role of autologous blood pleurodesis in modern thoracic surgery. We will conduct a prospective randomized controlled trial, enrolling VATS-lobectomy patients with an air leak present on the 1st postoperative day. Patients will be randomized to treatment with autologous blood or simple chest drainage.

Rationale

The most common postoperative complication following elective lung surgery is an alveolar-pleural fistula leading to postoperative air leakage, which leads to a postoperative pneumothorax because the negative intrapleural pressure disappears. The incidence varies in the literature between 25-50% on the first postoperative day. Definitions of prolonged air leakage varies in the medical literature. Thirty years ago, prolonged air leakage was considered when present after the seventh postoperative day. Other define postoperative air leakage prolonged after the fifth postoperative day, but now many consider any air leakage prolonged whenever it prolongs hospitalization. It is a relevant clinical problem because it not only leads to prolonged hospitalization and costs but also increases postoperative pain and morbidity.

Autologous blood pleurodesis was introduced 33 years ago as a treatment option in patients with pneumothorax. A recent meta-analysis concluded that the current evidence is outdated and highlight the need for up-to-date evidence to clarify the role of autologous blood pleurodesis in modern thoracic surgery. There only exists one randomized clinical control trial on this topic. The authors investigated blood pleurodesis in 22 patients who underwent lobectomy via open thoracotomy and found a benefit when administered on the fifth postoperative day. There are no previous studies that investigated if blood pleurodesis has a role earlier in the postoperative course. Because early postoperative blood pleurodesis could potentially reduce the length of chest tube duration, morbidity and subsequently shorten hospitalization, it would be clinically relevant.

Description of the cohort

We will conduct a prospective randomized controlled trial enrolling 182 patients undergoing elective VATS-lobectomy at the Department of Cardiothoracic Surgery, Odense University Hospital. Patients will be randomly assigned into two groups through web-based randomization. The intervention group will receive intrapleural instillation of autologous blood in accordance with the standard blood patch protocol at Odense University Hospital. Patients in the control group will be treated with a simple chest drain.

Data and biological material

Standard preoperative information on smoking status, medications, medical history of lung diseases, BMI, spirometry as well as DLCO measurements will be recorded. Detailed information about the surgical treatment will also be recorded (site of anatomical resection, adherences, standard perioperative assessment of air leakage, and type of mechanical linear staplers). Electronic recordings of air leakage from the electronic chest tube device will be analyzed from drain placement in the operating room, until drain removal.