Thoracoabdominal radical nephrectomy: Is a postoperative thoracostomy tubenecessary?

Objectives. To report our results of patients undergoing thoracoabdominal r adical nephrectomy without intraoperative placement of a thoracostomy tube. It has been routine in our hospital to not place a thoracostomy tube in pa tients undergoing thoracoabdominal radical nephrectomy since 1988. Methods. We conducted a retrospective review of 47 thoracoabdominal radical nephrectomies performed from January 1988 through November 1998 at our ins titution. Of the 47 patients, 39 did not have a thoracostomy tube placed in traoperatively; the other 8 patients did. The development of all postoperat ive complications, length of hospital stay, and hospital charges were noted . Results. No postoperative mortality was noted in our study. Of the 47 patie nts in the study, 20 patients had a total of 29 complications. The overall number of complications was not increased in the group without a thoracosto my tube compared with the group with a thoracostomy tube (P = 0.104). No pa tient treated without a thoracostomy tube required subsequent placement of a tube for persistent pneumothorax. The mean length of hospital stay in pat ients with a thoracostomy tube after radical nephrectomy was 9.14 +/- 2.65 days; in patients without a thoracostomy tube, the mean length of stay was 7.07 +/- 3.97 days (P = 0.071). Conclusions. In patients without parietal pleural injury, thoracoabdominal radical nephrectomy without the placement of a thoracostomy tube can be per formed safely and effectively, with a low risk of postoperative complicatio ns and a decrease in the overall hospital stay and hospital charges. UROLOG Y 55: 847-851, 2000. (C) 2000, Elsevier Science Inc.