Optimizing Outcomes in Lung Resection: Meta‑Analysis of Evidence-Based Interventions to Prevent and Manage Prolonged Air Leak

Background: Prolonged air leak (PAL) remains one of the most frequent and challenging complications after anatomical lung resection. PAL is associated with longer chest tube duration, increased postoperative complications, delayed discharge, and higher costs. Although various strategies—including digital chest drainage systems, low suction protocols, pleurodesis, sealants, and phrenic nerve cryoneuroablation—have been introduced, their benefits have not been consistently defined. Our objective is to evaluate the effect of different preventive and management interventions on the incidence of PAL, chest tube duration, and hospital stay following anatomical lung resection. Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized and observational studies that assessed strategies to prevent or reduce PAL after anatomical lung resection. Outcomes included PAL incidence, chest tube duration, and hospital length of stay. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models depending on heterogeneity. Results: Eight RCT studies including over 1,000 patients met the eligibility criteria. Pooled analysis demonstrated that these interventions significantly reduced the risk of PAL compared with standard care (OR = 0.45, 95% CI 0.28–0.72, p = 0.0009; I²= 14%). The interventions were also associated with a marked reduction in chest tube duration (MD = –1.12 days, 95% CI –1.19 to –1.06, p < 0.00001; I² = 94%) and a shorter hospital stay (MD = –0.59 days, 95% CI –0.87 to –0.31, p < 0.0001; I² = 66%). Conclusion: Interventions such as digital drainage systems, low suction protocols, pleurodesis, sealants, and phrenic nerve cryoneuroablation reduce PAL incidence and expedite recovery after anatomical lung resection. Their integration into standardized perioperative pathways can improve outcomes and resource utilization. Further multicenter studies are needed to confirm these findings and define optimal protocols.