Is prophylactic placement of drains necessary after subtotal gastrectomy?

AIM： To determine the evidence-based values of prophylactic drainage in gastric cancer surgery. METHODS： One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups. RESULTS： No significant differences were observed between the drain group and no-drain group in terms of operating time （171 ± 42 rain vs 156 ± 39 rain）, number of post-operative days until passage of flatus （3.7 ± 0.5 d vs 3.5 ± 1.0 d）, number of post-operative days until initiation of soft diet （4.9±0.7 d vs 4.8±0.8 d）, length of post-operative hospital stay （9.3±2.2 d vs 8.4±2.4 d）, mortality rate （5.4% vs 3.8%）, and overall postoperative complication rate （21.4% vs 19.2%）. CONCLUSION： Prophylactic drainage placement is not necessary afer subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.

Feasibility of totally laparoscopic gastrectomy without prophylactic drains in gastric cancer patients

BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed worldwide.However,reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few.AIM To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients.METHODS Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed.The outcomes between patients with and without prophylactic drainage were compared.RESULTS A total of 457 patients who underwent surgery for gastric cancer were identified.Of these,125 patients who underwent totally laparoscopic distal gastrectomy were included.After propensity score matching,data of 42 pairs were extracted.The incidence of concurrent illness was higher in the drain group(42.9%vs 31.0%,P=0.258).The overall postoperative complication rates were 19.5%and 10.6%in the drain(n=76)and no-drain groups(n=49),respectively;there were no significant differences between the two groups(P>0.05).The difference between the two groups based on the need for percutaneous catheter drainage was also not significant(9.8%vs 6.4%,P=0.700).However,patients with a larger body mass index(≥29 kg/m2)were prone to postoperative complications(P=0.042).In addition,the number of days from surgery until the first flatus(4.33±1.24 d vs 3.57±1.85 d,P=0.029)was greater in the drain group.CONCLUSION Omitting prophylactic drainage may reduce surgery time and result in faster recovery.Routine prophylactic drains are not necessary in selected patients.A prophylactic drain may be useful in high-risk patients.

Prophylactic drains in totally laparoscopic distal gastrectomy:are they always necessary?

Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than beneficial.Based on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all patients.Herein,we express our opinion regarding this interesting publication.