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Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy

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Abstract

Purpose

To systematically analyze the impact of prophylactic abdominal or retroperitoneal drain placement or omission in uro-oncologic surgery.

Methods

This systematic review follows the Cochrane recommendations and was conducted in line with the PRISMA and the AMSTAR-II criteria. A comprehensive database search including Medline, Web-of-Science, and CENTRAL was performed based on the PICO criteria. All review steps were done by two independent reviewers. Risk of bias was assessed with the Cochrane tool for randomized trials and the Newcastle–Ottawa Scale.

Results

The search identified 3427 studies of which eleven were eligible for qualitative and ten for quantitative analysis reporting on 3664 patients. Six studies addressed radical prostatectomy (RP), four studies partial nephrectomy (PN) and one study radical cystectomy. For RP a reduction in postoperative complications was found without drainage (odds ratio (OR)[95% confidence interval (CI)]: 0.62[0.44;0.87], p = 0.006), while there were no differences for re-intervention (OR[CI]: 0.72[0.39;1.33], p = 0.300), lymphocele OR[CI]: 0.60[0.22;1.60], p = 0.310), hematoma (OR[CI]: 0.68[0.18;2.53], p = 0.570) or urinary retention (OR[CI]: 0.57[0.26;1.29], p = 0.180). For partial nephrectomy no differences were found for overall complications (OR[CI]: 0.99[0.65;1.51], p = 0.960) or re-intervention (OR[CI]: 1.16[0.31;4.38], p = 0.820). For RC, there were no differences for all parameters. The overall-quality of evidence was assessed as low.

Conclusion

The omission of drains can be recommended for standardized RP and PN cases. However, deviations from the standard can still mandate the placement of a drain and remains surgeon preference. For RC, there is little evidence to recommend the omission of drains and future research should focus on this issue.

Review Registration Number (PROSPERO)

CRD42019122885

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Acknowledgements

We would like to thank Mr. M. Grilli from Mannheims’s University Library for conducting the literature search.

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Contributions

Kowalewski KF: Protocol development; Data collection; Data analysis; Manuscript writing. Hendrie JD: Data collection; Data analysis; Manuscript writing. Nickel F: Protocol development; Manuscript writing. von Hardenberg J: Data analysis; critical revision of manuscript. Nuhn P: Data analysis; critical revision of manuscript. Honeck P: critical revision and drafting of manuscript; data collection. Michel MS: Protocol development; critical revision of manuscript. Kriegmair MC: Protocol development; Manuscript writing; critical revision of manuscript.

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Correspondence to K. F. Kowalewski.

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Karl-Friedrich Kowalewski, Jonathan D. Hendrie, Jost von Hardenberg, Philipp Nuhn, Patrick Honeck, Maurice S. Michel and Maximillian C. Kriegmair have no conflicts of interest or financial ties to disclose. Felix Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, Medtronic and Intuitive Surgical Inc.

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Kowalewski, K.F., Hendrie, J.D., Nickel, F. et al. Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy. World J Urol 38, 1905–1917 (2020). https://doi.org/10.1007/s00345-019-02978-2

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