title: Predictive factors associated with prolonged chest drain production after esophagectomy.
abstract: After esophagectomy, pleural drainage is performed to ensure complete drainage of the pleural cavities. The aim of this study was to detect predisposing factors for prolonged drainage. Patients who underwent transhiatal or extended transthoracic esophagectomy for adenocarcinoma of the distal esophagus or gastroesophageal junction were included. Patients who underwent esophagectomy produced a median total drainage volume of 2477 mL (range 30-14,908). Seventy-five patients needed chest drainage = 7 days (short drainage) while 57 patients needed chest drainage > 7 days (prolonged drainage). Factors associated with prolonged drainage were a transthoracic approach (P < 0.001), a higher volume of blood loss (P = 0.027), a higher number of resected lymphnodes (P = 0.046) and a radical dissection (P = 0.033). Prolonged pleural drainage is associated with a transthoracic approach and is seen more often in patients after a microscopically radical dissection. Prolonged drainage is a sign of adequate dissection on the site of the primary tumor, probably due to the more extensive trauma to the lymphatic vessels in the mediastinum.
authors.affiliation: Department of Surgery, Academic Medical Center at University of Amsterdam, Amsterdam, the Netherlands. s.m.lagarde@amc.uva.nl
authors.forename: S M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: J M T
authors.initials: JM
authors.lastname: Omloo
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: O R C
authors.initials: OR
authors.lastname: Busch
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015505:Chest Tubes; D004322:Drainage; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection; D011184:Postoperative Period; D013997:Time Factors