Clinical Trial Details
— Status: Recruiting
Administrative data
NCT number |
NCT06411431 |
Other study ID # |
PSP-RCT |
Secondary ID |
|
Status |
Recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
October 3, 2023 |
Est. completion date |
December 2027 |
Study information
Verified date |
November 2023 |
Source |
Swedish Medical Center |
Contact |
Brian Louie, M.D. |
Phone |
206-215-6800 |
Email |
brian.louie[@]swedish.org |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Video-assisted thoracoscopic surgery (VATS) with blebectomy/wedge resection plus pleurodesis
is the standard of care for recurrent primary spontaneous pneumothorax (PSP) or, in certain
instances, after the first episode. The chest tube from surgery is typically kept to suction
until post-operative day (POD) 2 to allow for scarring of the lung to the chest to prevent
recurrence. However, the scarring process takes place over a period of weeks and is there no
data to support POD#2 as the best time to remove the chest tube. Also, shorter chest tube
duration can lower length of stay, patient discomfort, and hospital cost.
The goal of this randomized study is to determine if early removal (POD#1) of chest tube
after video-assisted thoracoscopic surgery (VATS) with blebectomy/wedge resection plus
chemical pleurodesis for primary spontaneous pneumothorax (PSP):
- has no worse 2-year recurrence rate compared to standard removal (POD#2)
- will lower length of stay compared to standard removal
- will result in less complications or re-interventions compared to standard removal
Participants will be asked to join prior to surgery. Following standard-of-care surgery,
participants will be screened for randomization. If still eligible, participants will be
randomized for early chest tube removal or standard removal. Early Removal will happen within
24 hours after surgery, with Standard Removal happening day 2 after surgery.
Participants will follow-up with the study team for 2 years on the following schedule:
- In clinic with a chest x-ray 2 weeks after surgery
- By phone 3 months after surgery
- In clinic with a chest x-ray 1 year after surgery
- In clinic with a chest x-ray 2 years after surgery
Description:
This study will be a multicentered randomized controlled trial. The trial will recruit all
adult subjects (>18 years old) with PSP who are undergoing VATS blebectomy/wedge resection
with chemical pleurodesis from participating centers. Subjects will be identified by the
surgical team when evaluating a subject with PSP for surgery. If screened eligible and not
meeting an exclusion criterion, the trial will be discussed with them, and consent will be
obtained.
Subjects will undergo VATS with resection of all visible disease or an apical wedge resection
if none is found. The use of reinforced or non-reinforced staple loads is left to surgeons'
preference. For pleurodesis, choice of chemical agent is at the desecration of the surgeon
and common practice but limited to 3 agents (talc, dextrose, or a tetracycline antibiotic).
Surgeons can choose to perform a mechanical pleurodesis as they deem appropriate. A single
apical chest tube will be placed and connected to a suction device set to at least -20 mmHg
of suction. Subjects will then be admitted overnight.
Subjects will be re-evaluated on the morning of POD#1. Those without an air leak, with <400
cc of non-bloody chest tube output, and having a maximum 1cm of apical pleural separation (as
determined by the surgeon) will be eligible for randomization to either early or standard
removal of their chest tube.
Randomization will occur in a 1:1 manner, stratified by participating center. Subjects within
the "Early Removal" group will have their chest tube removed on postoperative day 1 within 24
hours from the end of the surgery with a follow-up chest x-ray within 6 hours from removal in
addition to monitoring of symptoms. If the subject remains stable without developing symptoms
(new oxygen requirement, shortness of breath, etc.) or increased pleural separation on x-ray,
they will be eligible for discharge with appropriate follow-up.
Subjects in the "Standard Removal" group will keep their chest tube to suction until
postoperative day 2. The chest tube would be removed on POD#2 with a follow up chest x-ray
within 6 hours. If the subject remains stable without developing symptoms (new oxygen
requirement, shortness of breath, etc.) or growth of pleural separation on chest x-ray, they
would be eligible for discharge.
Subjects will then follow up in clinic within 2 weeks of the operation with a chest x-ray. A
3-month follow-up phone call will be performed. At 1-year post-operative, subjects again will
have standard clinic follow up and chest x-ray. Finally, a 2 year follow up phone call and
chest x-ray will be completed.