Prophylactic Drain Versus No Drain in Curative Gastric Cancer Surgery—A Randomized Controlled Trial

• Published in: Journal of gastrointestinal surgery Vol. 26; no. 12; pp. 2470 - 2476
• Main Authors: Muduly, Dillip Kumar, Imaduddin, Mohammed, Sultania, Mahesh, Houghton, Tim, G, Pavan Kumar C., Rao, P Bhaskar, Mitra, Jayanta Kumar, Behera, Bikram Kishore, Mohakud, Sudipta, Kar, Madhabananda
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2022; Springer Nature B.V
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Cancer surgery; Clinical trials; Gastrectomy - methods; Gastric cancer; Gastroenterology; Gastrointestinal surgery; Humans; Lymph Node Excision - methods; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prospective Studies; Randomized Controlled Trials as Topic; Recovery (Medical); Stomach Neoplasms - pathology; Surgery; Drain; Gastrectomy; Gastric cancer; Morbidity; Hospital stay
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-022-05480-0

Background The adoption of enhanced recovery after surgery protocols has questioned the placement of prophylactic drain after curative gastrectomy. A 2015 Cochrane meta-analysis did not find convincing evidence of routine drain placement in gastrectomy, but the quality of evidence was questioned. The present study compared short-term outcomes of prophylactic drain placement versus no drain in gastrectomy. Methodology The study is a prospective, non-inferiority, and randomized controlled trial. Histologically proven adenocarcinoma of the stomach undergoing curative gastrectomy with D2 lymphadenectomy was included in the study. Randomization was done intra-operatively. The primary outcome was a postoperative hospital stay. Secondary outcomes included the return of bowel function, achieving adequate enteral feeding, re-surgery, morbidity, and mortality. Results One hundred fifty-seven patients were registered, of which 108 patients underwent curative surgery, and were randomized to 54 patients in each group. The median age was 55 years (range: 23–78) and 58.5 years (range: 35–80) in the drain and no drain group. No significant difference was noticed in primary or secondary outcomes in both groups. Conclusion Avoid placing a prophylactic drain is not inferior to drain placement following gastrectomy with D2 lymphadenectomy for stomach adenocarcinoma. So, routine prophylactic drain placement can be avoided.