Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Abdominal Drainage in the Prevention and Management of Major Intra-Abdominal Complications after Total Gastrectomy for Gastric Carcinoma

  • Lim, Soo Young (Department of Surgery, Chonnam National University Medical School) ;
  • Kang, Ji Hoon (Department of Surgery, Chonnam National University Medical School) ;
  • Jung, Mi Ran (Department of Surgery, Chonnam National University Medical School) ;
  • Ryu, Seong Yeob (Department of Surgery, Chonnam National University Medical School) ;
  • Jeong, Oh (Department of Surgery, Chonnam National University Medical School)
  • Received : 2020.07.06
  • Accepted : 2020.10.15
  • Published : 2020.12.31
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Abstract

Purpose: The role of prophylactic abdominal drainage in total gastrectomy is not well-established. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma. Materials and Methods: We retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas. Results: The drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The non-drainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications. Conclusions: Prophylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. https://doi.org/10.3322/caac.21492
  2. Papenfuss WA, Kukar M, Oxenberg J, Attwood K, Nurkin S, Malhotra U, et al. Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol 2014;21:3008-3014. https://doi.org/10.1245/s10434-014-3664-z
  3. Petrowsky H, Demartines N, Rousson V, Clavien PA. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 2004;240:1074-1084. https://doi.org/10.1097/01.sla.0000146149.17411.c5
  4. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World J Surg 2019;43:659-695. https://doi.org/10.1007/s00268-018-4844-y
  5. Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg 2014;101:1209-1229. https://doi.org/10.1002/bjs.9582
  6. Ahn HS, Yook JH, Park CH, Park YK, Yu W, Lee MS, et al. General perioperative management of gastric cancer patients at high-volume centers. Gastric Cancer 2011;14:178-182. https://doi.org/10.1007/s10120-011-0012-x
  7. Jeong O, Kim HG. Implementation of Enhanced Recovery after Surgery (ERAS) program in perioperative management of gastric cancer surgery: a nationwide survey in Korea. J Gastric Cancer 2019;19:72-82. https://doi.org/10.5230/jgc.2019.19.e3
  8. Kim J, Lee J, Hyung WJ, Cheong JH, Chen J, Choi SH, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg 2004;8:727-732. https://doi.org/10.1016/j.gassur.2004.05.018
  9. Kumar M, Yang SB, Jaiswal VK, Shah JN, Shreshtha M, Gongal R. Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gastroenterol 2007;13:3738-3741. https://doi.org/10.3748/wjg.v13.i27.3738
  10. Alvarez Uslar R, Molina H, Torres O, Cancino A. Total gastrectomy with or without abdominal drains. A prospective randomized trial. Rev Esp Enferm Dig 2005;97:562-569.
  11. Wang Z, Chen J, Su K, Dong Z. Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev 2015;CD008788.
  12. Amin M, Edge S, Greene F, Byrd D, Brookland R, Washington M, et al., eds. AJCC Cancer Staging Manual. 8th ed. New York (NY): Springer; 2017
  13. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112. https://doi.org/10.1007/s10120-011-0041-5
  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  15. Guideline Committee of the Korean Gastric Cancer Association (KGCA). Development Working Group & Review Panel. Koran practice guidelines for gastric cancer 2018: an evidence-based, multidisciplinary approach. J Gastric Cancer 2019;19:1-48. https://doi.org/10.5230/jgc.2019.19.e8
  16. Dann GC, Squires MH 3rd, Postlewait LM, Kooby DA, Poultsides GA, Weber SM, et al. Value of peritoneal drain placement after total gastrectomy for gastric adenocarcinoma: a multi-institutional analysis from the US Gastric Cancer Collaborative. Ann Surg Oncol 2015;22 Suppl 3:S888-S897.
  17. Saito A, Murakami M, Otsuka K, Yamazaki K, Komoto M, Kato R, et al. Efficacy of prophylactic drain placement in laparoscopic total gastrectomy: a retrospective study. Int Surg 2020;104:33-38. https://doi.org/10.9738/intsurg-d-16-00111.1
  18. Lee J, Choi YY, An JY, Seo SH, Kim DW, Seo YB, et al. Do all patients require prophylactic drainage after gastrectomy for gastric cancer? The experience of a high-volume center. Ann Surg Oncol 2015;22:3929-3937. https://doi.org/10.1245/s10434-015-4521-4
  19. Schots JPM, Luyer MDP, Nieuwenhuijzen GAP. Abdominal drainage and amylase measurement for detection of leakage after gastrectomy for gastric cancer. J Gastrointest Surg 2018;22:1163-1170. https://doi.org/10.1007/s11605-018-3789-7