Rachel M Lee1, Adriana C Gamboa1, Michael K Turgeon1, Sanjana Prasad2, Gifty Kwakye2, Maryam Mohammed3, Jennifer Holder-Murray3, Sherif Abdel-Misih4, Charles Kimbrough4, Mosope Soda5, Alexander T Hawkins5, William C Chapman6, Matthew Silviera6, Shishir K Maithel1, Glen Balch7. 1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 2. Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 3. Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA. 5. Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, St. Louis, MO, USA. 6. Section of Colon & Rectal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. 7. Division of Colon & Rectal Surgery, Department of Surgery, Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA. glen.c.balch@emory.edu.
Abstract
BACKGROUND: Intraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was to assess the validity of this practice. METHODS: Patients from the US Rectal Cancer Consortium (2007-2017) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection (SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low anastomoses < 6 cm from the anal verge. RESULTS: Of 996 patients 67% (n = 551) received a drain. Drain patients were more likely to be male (64 vs 54%), have a smoking history (25 vs 19%), have received neoadjuvant chemoradiation (73 vs 61%), have low tumors (56 vs 36%), and have received a DLI (80 vs 71%) (all p < 0.05). Drains were associated with an increased anastomotic leak rate (14 vs 8%, p = 0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82 vs 88%, p = 0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12 vs 10%, p = 0.478) and readmission rates (28 vs 31%, p = 0.511) were similar. CONCLUSIONS: Although not associated with increased infectious complications, intraoperatively placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage appears to be unnecessary.
BACKGROUND: Intraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was to assess the validity of this practice. METHODS: Patients from the US Rectal Cancer Consortium (2007-2017) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection (SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low anastomoses < 6 cm from the anal verge. RESULTS: Of 996 patients 67% (n = 551) received a drain. Drain patients were more likely to be male (64 vs 54%), have a smoking history (25 vs 19%), have received neoadjuvant chemoradiation (73 vs 61%), have low tumors (56 vs 36%), and have received a DLI (80 vs 71%) (all p < 0.05). Drains were associated with an increased anastomotic leak rate (14 vs 8%, p = 0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82 vs 88%, p = 0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12 vs 10%, p = 0.478) and readmission rates (28 vs 31%, p = 0.511) were similar. CONCLUSIONS: Although not associated with increased infectious complications, intraoperatively placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage appears to be unnecessary.
Authors: Davide Cavaliere; Georgi Popivanov; Diletta Cassini; Roberto Cirocchi; Brandon M Henry; Nereo Vettoretto; Giorgio Ercolani; Leonardo Solaini; Chiara Gerardi; Mihail Tabakov; Krzysztof Andrzej Tomaszewski Journal: Int J Colorectal Dis Date: 2019-04-25 Impact factor: 2.571
Authors: Vahagn C Nikolian; Neil S Kamdar; Scott E Regenbogen; Arden M Morris; John C Byrn; Pasithorn A Suwanabol; Darrell A Campbell; Samantha Hendren Journal: Surgery Date: 2017-02-21 Impact factor: 3.982