Necessity of routine thoracostomy tube insertion after transhiatal esophagectomy

Introduction: Transhiatal esophagectomy is a widely accepted approach for palliative resection of subcarinal esophageal cancers. This study was designed to evaluate the necessity of routine thoracostomy tube insertion in this technique. Methods: This descriptive study was conducted on 123 consecutive patients with esophageal cancers undergoing transhiatal esophagectomy from March 2001 to February 2005. Chest tube insertion was performed according to our defined criteria. Thoracostomy tube would be inserted intraoperatively, if the estimated amount of bleeding was more than 200 ml. In patients with unilateral or bilateral diffuse haziness in chest-x-ray representative of considerable fluid collection, and symptomatic patients with each amount of pleural fluid, it would be inserted postoperatively. Results: Thoracostomy tube was intraoperatively inserted in 41 cases (33.3%). Among other 82 patients only 19 cases (15.4%) required chest tube during admission period. There was significant relation between intraoperatively and postoperatively inserted thoracostomy tubes (p<0.001). There was no statistically relation between chest tube insertion and hospital mortality (p=0.71). The mortality rate didn’t show a significant relation with the amount of chest tube drainage (p=0.056). Conclusions: Routine intraoperative chest tube insertion is not necessary for all patients following THE, and it should be limited to the patients with significant intrathoracic bleeding.