Skipping prophylactic drainage raises post-gastrectomy reoperation risk by 7.2%
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Key takeaways:
- Fewer patients in the prophylactic drainage group required invasive postoperative intervention (7.7% vs. 15%).
- Reoperation, not percutaneous drain placement, drove the difference in the composite endpoint.
A no-drain strategy after gastrectomy increased the risk for reoperation or percutaneous drain placement within 30 days compared with prophylactic drainage among patients with gastric cancer, according to a study published in JAMA Surgery.
“Prophylactic drainage aims to identify and treat intraperitoneal fluid collections from surgical complications,” Jacopo Weindelmayer, MD, of the division of general and upper GI surgery at Borgo Trento Hospital in Verona, Italy, and colleagues wrote. “However, its routine use has been questioned following evidence from colorectal surgery studies and Enhanced Recovery After Surgery protocols.”
They continued, “Currently, prophylactic drainage is widespread internationally.”
In the prospective, randomized, noninferiority Abdominal Drain in Gastrectomy Trial, Weindelmayer and colleagues investigated the impact of routine abdominal drainage compared with nondrainage on the need for invasive postoperative procedures.
They enrolled 390 patients (median age, 71 years; 57.9% men) with gastric or esophagogastric junction cancer from 11 centers in Italy, of whom 196 and 194 underwent gastrectomy with vs. without prophylactic drainage, respectively. Patient follow-up occurred at 30 and 90 days, and outcomes of interest included the rate of reoperation or percutaneous drainage within 30 days after surgery.
According to results from the modified intention-to-treat analysis, 7.7% of patients in the drainage group required invasive postoperative procedures by day 30 compared with 15% in the nondrainage group. This corresponded with a difference of 7.2% (90% CI, 2.1-12.4), which favored prophylactic drainage. Researchers noted the difference in the composite endpoint was driven by the rate of reoperation between groups (5.1% vs. 12.4%), rather than percutaneous drain placement (2.6% in both groups).
Additional results demonstrated a “significant” escalation in the required level of care among those in the nondrainage group (6.6% vs. 14.4%).
“Our findings underscore a significant increase in the risk of postoperative invasive interventions, including reoperation and percutaneous drain insertion, when opting for a no-drain strategy compared to a prophylactic drain,” Weindelmayer and colleagues wrote. “While previous trials aimed to assess the impact of drains on patient recovery and complications, it is important to emphasize that drains primarily serve to prevent and treat postoperative abdominal abscesses, regardless of the underlying cause, rather than reducing complications.”
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