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

Table 1 Characteristics of patients who underwent totally laparoscopic distal gastrectomy with or without prophylactic drain

	ALL patients			Propensity-matched patients
Characteristic	Drain (n = 76)	No drain (n = 49)	P value	Drain (n = 42)	No drain (n = 42)	P value
Sex (M/F)	54/22	33/16	0.660	31/11	29/13	0.629
Age	57.58 ± 9.90	54.14 ± 12.63	0.092	57.4 ± 9.9	58.1 ± 10.8	0.739
BMI (kg/m2)	24.71 ± 3.76	24.64 ± 3.72	0.915	24.3 ± 3.5	24.4 ± 2.7	0.879
ASA (1/2/3), n (%)			0.562			0.565
1	1 (1.3)	0 (0.0)		1 (2.4)	0 (0.0)
2	70 (92.1)	44 (89.8)		38 (90.5)	38 (90.5)
3	5 (6.6)	5 (10.2)		3 (7.1)	4 (9.5)
pT stage, n (%)			0.605			0.805
T1	39 (52.0)	24 (49.0)		20 (47.6)	20 (47.6)
T2	10 (13.3)	11 (22.4)		6 (14.3)	10 (23.8)
T3	9 (12)	5 (10.2)		6 (14.3)	4 (9.5)
T4a	17 (22.7)	9 (18.4)		10 (23.8)	8 (19)
pN stage, n (%)			0.888			0.760
N0	34 (44.7)	20 (40.8)		16 (38.1)	18 (42.9)
N1	16 (21.1)	12 (24.5)		9 (21.4)	11 (26.2)
N2	14 (18.4)	7 (14.3)		9 (21.4)	5 (11.9)
N3	12 (15.8)	10 (20.4)		8 (19)	8 (19)
Previous abdominal operation, n (%)	13 (17.1)	13 (26.5)	0.205	6 (14.3)	10 (23.8)	0.266
Neoadjuvant chemotherapy, n (%)	5 (6.6)	2 (4.1)	0.704	4 (9.5)	2 (4.8)	0.676
Concurrent illness, n (%)	34 (44.7)	14 (28.6)	0.070	18 (42.9)	13 (31.0)	0.258

ASA: American Society of Anesthesiologists; pT: Primary tumor; pN: Regional lymph node; BMI: Body mass index.

Table 2 Operative findings

Variable	All patients			Propensity-matched patients
	Drain (n = 76)	No drain (n = 49)	P value	Drain (n = 42)	No drain (n = 42)	P value
Operation time (min)	198.4 ± 41.0	164.0 ± 37.0	< 0.001	180.2 ± 33.4	168.0 ± 36.7	0.113
Estimated blood loss (mL)	85.3 ± 80.7	70.82 ± 51.5	0.267	72.9 ± 45.8	73.8 ± 54.4	0.931
Intraoperative blood transfusion, n (%)	2 (2.6)	2 (4.1)	0.645	1 (2.4)	2 (4.8)	1.000
Tumor size (cm)	3.5 ± 1.6	3.6 ± 1.5	0.664	3.6 ± 1.7	3.5 ± 1.4	0.839
No. of retrieved lymph nodes	36.7 ± 13.7	39.1 ± 14.2	0.346	40.0 ± 11.2	40.0 ± 15.1	0.923

Table 3 Recovery

Variable	All patients			Propensity-matched patients
	Drain (n = 76)	No drain (n = 49)	P value	Drain (n = 42)	No drain (n = 42)	P value
Time to ambulation, POD	2.51 ± 1.34	2.98 ± 1.39	0.064	2.90 ± 1.54	3.07 ± 1.44	0.610
Time to first flatus, POD	3.97 ± 1.24	3.55 ± 1.79	0.122	4.33 ± 1.24	3.57 ± 1.85	0.029
Time to first eating of soft diet, POD	4.70 ± 2.17	4.14 ± 2.09	0.159	5.02 ± 1.88	4.17 ± 2.20	0.058
Postoperative hospital stay	7.88 ± 3.96	6.73 ± 5.13	0.164	7.93 ± 4.98	6.81 ± 5.50	0.331
CRP	7.54 ± 4.38	8.53 ± 5.91	0.286	7.66 ± 3.89	8.71 ± 5.95	0.339
Tmax	37.6 ± 0.5	37.5 ± 0.4	0.239	37.60 ± 0.60	37.48 ± 0.40	0.300

POD: Postoperative days.

Table 4 Postoperative complications

	All patients			Propensity-matched patients
Complication, n	Drain (n = 76), n (%)	No drain (n = 49), n (%)	P value	Drain (n = 42), n (%)	No drain (n = 42), n (%)	P value
Total	12(15.8)	5 (10.2)	0.374	8 (19.0)	4 (9.5)	0.212
Clavien–Dindo grade II	4 (5.2)	2 (4.0)		3 (7.2)	1 (2.4)
Incision	1 (1.3)	1 (2.0)		0 (0.0)	0 (0.0)
System complications	1 (1.3)	1 (2.0)		1 (2.4)	1 (2.4)
Abdominal effusion	2 (2.6)	0 (0.0)		2 (4.8)	0 (0.0)
Clavien–Dindo grade III	8 (10.6)	3 (6.0)		5 (12)	3 (7.2)
Duodenal stump leakage	2 (2.6)	0 (0.0)		2 (2.4)	0 (0.0)
Anastomotic Leakage	2 (2.6)	0 (0.0)		0 (0.0)	0 (0.0)
Intra-abdominal bleeding	1 (1.3)	0 (0.0)		1 (2.4)	0 (0.0)
Intra-abdominal abscess	3 (3.9)	2 (4.0)		2 (2.4)	2 (2.4)
Pleural effusion	0 (0.0)	1 (2.0)		0 (0.0)	1 (2.4)
Mortality	0 (0.0)	0 (0.0)	1	0 (0.0)	0 (0.0)	1

PCD: Percutaneous catheter drainage.

Table 5 Risk assessment for the occurrence of postoperative complication

Variable	Postoperative complications (+) (n = 17)	Postoperative complications (-) (n = 108)	P value
Sex			0.584
Male	13	74
Female	4	34
Age	59.59 ± 9.62	55.70 ± 11.30	0.182
BMI (kg/m2), n (%)	27.44 ± 3.92	24.25 ± 3.53	0.001
≥ 29	5 (38.5)	10 (13.3)	0.042
< 29	8 (61.5)	65 (86.7)
ASA (1/2/3), n (%)			0.769
1	0 (0.0)	1 (100.0)
2	15 (13.2)	99 (86.8)
3	2 (20.0)	8 (80.0)
Preoperative ALB (g)	39.62 ± 4.65	40.18 ± 5.86	0.709
Preoperative HGB (g/L)	136.59 ± 17.77	135.26 ± 19.36	0.791
pT stage, n (%)			0.776
T1	7 (38.5)	56 (49.3)
T2	4 (23.1)	17 (20.0)
T3	3 (15.4)	11 (8.0)
T4a	3 (23.1)	23 (22.7)
pN stage, n (%)			0.872
N0	8 (38.5)	46 (45.3)
N1	3 (15.4)	25 (22.7)
N2	3 (23.1)	18 (13.3)
N3	3 (23.1)	19 (18.7)
Previous abdominal operation			0.103
Yes	1	25
No	16	83
Neoadjuvant chemotherapy			0.234
Yes	2	5
No	15	103
Concurrent illness			0.800
Yes	7	41
No	10	67
Drain, n (%)	12 (15.8)	64 (84.2)	0.374
No drain, n (%)	5 (10.2)	44 (89.8)
Type of reconstruction, n (%)			0.357
Billroth I	4 (30.8)	32 (36.0)
Billroth II	10 (61.5)	69 (64.0)
Roux-en-Y	3 (7.7)	7 (0.0)
Operative time (min)	195.82 ± 49.12	183.16 ± 41.69	0.258
Blood loss (mL)	62.94 ± 42.54	82.22 ± 74.07	0.298

ASA: American Society of Anesthesiologists; BMI: Body mass index; ALB: Albumin; HGB: Hemoglobin; pT: Primar tumor; pN: Regional lymph node.