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Background: The aim of this meta-analysis and systematic review of published evidence was to optimize chest tube management for fast-track rehabilitation of lung cancer patients after video-assisted thoracic surgery (VATS). Methods: The PubMed, Web of Science, and EMBASE databases were searched to identify all studies that addressed the issue of chest tube management after VATS for lung cancer. Finally, 35 articles were included for analysis, i.e., 29 randomized controlled trials and 6 clinical trials. Results: After synthesis of the published evidence, the following protocol for chest tube drainage was formulated: (1) after VATS lung wedge resection, chest tube drainage can be omitted in selected cases; (2) normally, one 28Fr chest tube (or 19Fr Blake drain) is placed; (3) the use of a digital monitoring system is recommended; (4) in case of increasing pneumothorax or severe air leakage supported by digital recording system, the tube should be placed with active suction; and (5) the chest tube can be removed within 48 h postoperatively when air leakage is resolved and fluid drainage is <400 mL/day. Conclusions: Further multicenter studies are warranted based on the variations of body sizes among different ethnicities. [ABSTRACT FROM AUTHOR]

The article focuses on a study regarding the consequences and antecedents of international marketing program adaptation or standardization through a meta-analysis. The study analyzes the interdependence between the component of marketing-mix strategy in international performance using multivariate analysis. Moreover, meta-regression analysis was also applied to examine the subgroups as potential moderators in the relationships on marketing-standardization performance.

Abstract: Objectives: The decision to proceed to simple underwater seal drainage or to apply active suction to the underwater seal following pulmonary operation is a controversial one. For the sake of selecting the alternative to reduce postoperative air leakage, we performed a meta-analysis of randomised controlled trials (RCTs) to determine the benefit of suction or non-suction following lung surgery on patient outcomes. Methods: RCTs published in English from 1999 to 2009 were included. A fixed-effect model was developed for postoperative pneumothorax cases. A random-effects model was developed for quantitative data synthesis, including prolonged air-leak cases, duration of air leakage, time for the removal of chest tubes and hospital stay. Results: Odds ratio (95% confidence interval (CI)), expressed as suction versus non-suction, was 0.11 (0.03–0.49) for postoperative pneumothorax cases; relative risk was 1.48 (0.82–2.70) for prolonged air-leakage cases; weighted mean difference was 1.16 (−0.63 to 2.94) for the duration of air leakage, 0.96 (−0.12 to 2.05) for the time for removal of chest tubes and 2.19 (0.61–4.98) for the hospital stay. Conclusion: There is no necessity to use suction in most cases, since it cannot decrease the incidence of prolonged air leak. However, suction can reduce the occurrence of postoperative pneumothorax resulting from early air leak. As a result, the early use of postoperative suction might be crucial to specific patients to whom early elimination of residual space is very important. [Copyright &y& Elsevier]