Liu H, Jin P, Quan X, Xie YB, Ma FH, Ma S, Li Y, Kang WZ, Tian YT. Feasibility of totally laparoscopic gastrectomy without prophylactic drains in gastric cancer patients. World J Gastroenterol 2021; 27(26): 4236-4245 [PMID: 34326622 DOI: 10.3748/wjg.v27.i26.4236]
Corresponding Author of This Article
Yan-Tao Tian, MD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hao Liu, Peng Jin, Xu Quan, Yi-Bin Xie, Fu-Hai Ma, Shuai Ma, Yang Li, Wen-Zhe Kang, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hao Liu, Department of Gastrointestinal Surgery, The Second Hospital, Jilin University, Changchun 130041, Jilin Province, China
Author contributions: Liu H and Jin P contributed equally to this work; Xie YB and Xu Q designed the research; Liu H, Jin P, and Ma FH analyzed the data and wrote the main manuscript text; Li Y, Kang WZ, and Ma S collected the patients’ clinical data; Tian YT was involved in study conception and design, data interpretation, manuscript revision, and discussion.
Supported byNational Natural Science Foundation of China, No. 81772642; and Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: Some or all data and code generated or used during the study are available from the corresponding author by request
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: November 10, 2020 Peer-review started: November 10, 2020 First decision: November 30, 2020 Revised: December 16, 2020 Accepted: March 29, 2021 Article in press: March 29, 2021 Published online: July 14, 2021 Processing time: 243 Days and 14 Hours
Abstract
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.
Core Tip: We reviewed the outcomes of 125 consecutive 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. We found that performing totally laparoscopic gastrectomy without prophylactic drains in selected patients is possible. It significantly improved postoperative comfort and did not increase the risk of postoperative complications.
