Impact of pleural lavage fluid volume on perioperative outcomes in non-small cell lung cancer patients undergoing video-assisted thoracoscopic lobectomy: a randomized controlled trial

Background: The optimal volume for pleural lavage during lung cancer surgery remains controversial, despite its recognized importance in thoracic cavity decontamination, tumor cell clearance, and prevention of postoperative complications. This study assessed the impact of varying lavage volumes on perioperative outcomes in non-small cell lung cancer (NSCLC) patients, with the objective of establishing evidence-based procedural guidelines. Methods: Participants underwent lobectomy for NSCLC were randomly assigned to receive either 1,000 or 250 mL of pleural lavage before chest closure. The primary outcome was overall fever rates, and secondary outcomes included complication rates, drainage parameters, and length of hospital stay. Results: A total of 415 patients were screened, and 406 were randomized to either the 1,000 mL (n=206) or 250 mL (n=200) groups. Postoperative fever (≥37.3 ℃) occurred in 23.08% of the 1,000 mL group and 17.01% of the 250 mL group (P=0.17). The fever rates at ≥38 ℃ were similar between groups (5.13% vs. 4.12%, P=0.82). A temporal difference in fever progression was observed, with the 1,000 mL group peaking 24 hours earlier on postoperative day 1 (POD1) evening, while the 250 mL group peaked on POD2 evening. Postoperative pneumonias were comparable (1.54% vs. 1.55%, P>0.99) between groups. Surgery duration, drainage volume, and cost were slightly more favorable in the 250 mL group, though not statistically significant. Conclusions: A volume of 250 mL pleural lavage demonstrated comparable efficacy to 1,000 mL in controlling postoperative fever and complications, while showing trends toward reduced resource utilization (shorter surgery duration, lower drainage volume and cost). Trial Registration: The trial protocol was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1900021950) before patient enrollment.