Is pleural effusion a normal occurrence after pulmonary lobectomy (lung lobectomy)?

From the Guidelines

Yes, it is normal to have pleural effusion after a lobectomy. Pleural effusion, which is an accumulation of fluid in the space between the lungs and chest wall, commonly occurs following lung surgery, as stated in the European Respiratory Journal 1. This is an expected part of the healing process as the body responds to the surgical trauma. Most patients will have some degree of pleural effusion after a lobectomy, which is typically managed with chest tubes placed during surgery to drain the fluid.

Key Points to Consider

• The fluid often appears bloody initially and then transitions to a more clear, straw-colored fluid as healing progresses.
• While most pleural effusions resolve with standard postoperative care, persistent or large effusions may require additional interventions such as thoracentesis or placement of additional drainage tubes.
• Patients should be aware that some degree of chest discomfort, shortness of breath, and decreased breath sounds on the surgical side are normal during this recovery period, but severe symptoms should prompt medical evaluation to rule out complications such as infection or significant fluid reaccumulation.
• According to the European Respiratory Journal 1, postoperative pleural effusions are divided into “early” and “late” categories depending on the time of onset following surgery, with early effusions being more often related to the trauma and bleeding of surgery itself, and late effusions suggesting an immune-mediated response.
• The use of a digital chest drainage system for postoperative suction drainage is probably recommended to enhance recovery after surgery, reduce chest drainage time, and decrease the length of stay, as suggested in the guidelines on enhanced recovery after pulmonary lobectomy 1.
• A single chest drain for management of postoperative pleural effusion is recommended, with removal of the chest drain as soon as possible, or when serous pleural drainage is <300 mL/day, as stated in the guidelines on enhanced recovery after pulmonary lobectomy 1.

Management and Treatment

• The management of postoperative pleural effusions typically involves the use of chest tubes to drain the fluid, with the goal of reducing the amount of fluid in the pleural space and promoting healing.
• In some cases, additional interventions such as thoracentesis or placement of additional drainage tubes may be necessary to manage persistent or large effusions.
• The decision to intervene is usually based on a combination of clinical and radiological features, rather than individual parameters, as stated in the European Respiratory Journal 1.
• Ultrasound-guided thoracocentesis has largely replaced the need for more invasive surgical tube thoracostomy and is both effective and well tolerated by patients, as reported in the European Respiratory Journal 1.

From the Research

Pleural Effusion after Lobectomy

• Pleural effusion is an excessive accumulation of fluid in the pleural space, which can occur after thoracic surgery, including lobectomy 2.
• The etiology of pleural effusion remains unclear in nearly 20% of cases, and thoracocentesis should be performed for new and unexplained pleural effusions to determine the underlying cause 3.
• Persistent postoperative pleural effusion can occur after thoracic surgery, including lobectomy, and may lead to progressive dyspnea and a prolonged hospital stay 2.
• The incidence of postoperative pleural effusion can be reduced with adequate chest tube management and postoperative physical therapy 2.

Causes and Management

• Pleural effusions can be caused by various conditions, including pneumonia, congestive heart failure, and malignancy 4, 5.
• The management of pleural effusion depends on the underlying etiology, and may include drainage of the effusion, treatment of the underlying condition, and pleurodesis to prevent recurrence 3, 2.
• In some cases, pleural effusion may reaccumulate after drainage, and repeated drainage or other interventions may be necessary 6.

Clinical Considerations

• Patients with pleural effusion may present with symptoms such as dyspnea, cough, and pleuritic chest pain 3.
• The diagnosis of pleural effusion is typically made using imaging studies, such as chest X-ray or CT scan, and thoracocentesis to analyze the pleural fluid 3, 5.
• The treatment of pleural effusion should be individualized based on the underlying cause and the patient's clinical condition 3, 2.