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Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma: A Multi-institutional Analysis from the US Gastric Cancer Collaborative

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established.

Methods

Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified. The association of PD placement with postoperative outcomes was analyzed.

Results

Overall, 344 patients were identified and 253 (74 %) patients received a PD. The anastomotic leak rate was 9 %. Those with PD placement had similar American Society of Anesthesiologists score, tumor size, TNM stage, and the need for additional organ resection when compared with their counterparts. No difference was observed in the rate of any complication (54 vs. 48 %; p = 0.45), major complication (25 vs. 24 %; p = 0.90), or 30-day mortality (7 vs. 4 %; p = 0.51) between the two groups. In addition, no difference in anastomotic leak (9 vs. 10 %; p = 0.90), the need for secondary drainage (10 vs. 9 %; p = 0.92), or reoperation (13 vs. 8 %; p = 0.28) was identified. On multivariate analysis, PD placement was not associated with decreased postoperative complications. Subset analysis, stratified by patients who did not undergo concomitant pancreatectomy (n = 319) or those who experienced anastomotic leak (n = 31), similarly demonstrated no association of PD placement with reduced complications or mortality.

Conclusions

PD placement after total gastrectomy for GAC is associated with neither a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, nor a decrease in the need for secondary drainage procedures or reoperation. Routine use of PDs is not warranted.

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References

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

    Article  PubMed  Google Scholar 

  2. Brown LM, Devesa SS. Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin N Am. 2002;11:235–56.

    Article  PubMed  Google Scholar 

  3. Hansson LE, Sparen P, Nyren O. Increasing incidence of carcinoma of the gastric cardia in Sweden from 1970 to 1985. Br J Surg. 1993;80:374–7.

    Article  PubMed  CAS  Google Scholar 

  4. Steevens J, Botterweck AA, Dirx MJ, et al. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol. 2010;22:669–78.

    PubMed  Google Scholar 

  5. Vial M, Grande L, Pera M. Epidemiology of adenocarcinoma of the esophagus, gastric cardia, and upper gastric third. Recent Results Cancer Res. 2010;182:1–17.

    Article  PubMed  Google Scholar 

  6. Dassen AE, Lemmens VE, van de Poll-Franse LV, et al. Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands. Eur J Cancer. 2010;46:1101–10.

    Article  PubMed  CAS  Google Scholar 

  7. Piazuelo MB, Correa P. Gastric cancer: overview. Colomb Med (Cali). 2013;44:192–201.

    PubMed  Google Scholar 

  8. Smyth EC, Capanu M, Janjigian YY, et al. Tobacco use is associated with increased recurrence and death from gastric cancer. Ann Surg Oncol. 2012;19:2088–94.

    Article  PubMed  CAS  Google Scholar 

  9. Song Q, Wang J, Jia Y, et al. Shorter dinner-to-bed time is associated with gastric cardia adenocarcinoma risk partly in a reflux-dependent manner. Ann Surg Oncol. 2014;21:2615–9.

    Article  PubMed  Google Scholar 

  10. Ajani JA, Bentrem DJ, Besh S, et al. National Comprehensive Cancer Network. Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2013;11(5):531–46.

    PubMed  CAS  Google Scholar 

  11. Wang Z, Chen J, Su K, Dong Z. Abdominal drainage versus no drainage post gastrectomy for gastric cancer. Cochrane Database Syst Rev. 2011;(8):CD008788. doi:10.1002/14651858.CD008788.pub2.

  12. Petrowsky H, Demartines N, Rousson V, Clavien PA. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg. 2004;240(6):1074–84; discussion 1084–5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Conlon KC, Labow D, Leung D, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg. 2001;234(4):487–93; discussion 493–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  14. Correa-Gallego C, Brennan MF, Dʼangelica M, et al. Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution. Ann Surg. 2013;258(6):1051–8.

    Article  PubMed  Google Scholar 

  15. Mehta VV, Fisher SB, Maithel SK, Sarmiento JM, Staley CA, Kooby DA. Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies. J Am Coll Surg. 2013;216(4):635–42; discussion 642–4.

    Article  PubMed  Google Scholar 

  16. Van Buren G 2nd, Bloomston M, Hughes SJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg. 2014;259(4):605–12.

    Article  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dougherty HH, Simmons RL. The biology and practice of surgical drains. Part 1 Curr Probl Surg. 1992;29:559–730.

    Article  PubMed  CAS  Google Scholar 

  19. Kim J, Lee J, Hyung WJ, Cheong JH, Chen J, Choi SH, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004;8 (6):727–32.

    Article  PubMed  Google Scholar 

  20. Kumar M, Yang SB, Jaiswal VK, Shah JN, Shreshtha M, Gongal R. Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gastroenterol. 2007;13(27):3738–41.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jiang ZW, Li JS, Wang ZM, Li N, Diao YQ, Huang XJ. Prospective randomized study of abdominal drains in gastric cancer surgery. Chin J Pract Surg. 2008;28(9):761–2.

    Google Scholar 

  22. Álvarez Uslar R, Molina H, Torres O, Cancino A. Total gastrectomy with or without abdominal drains: a prospective randomized trial. Revista Espanola de Enfermedades Digestivas 2005;97(8):562–9.

    PubMed  Google Scholar 

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Acknowledgment

This study is supported in part by the Katz Foundation.

Disclosure

None.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Gregory C. Dann BS, Malcolm H. Squires III MD, MS, Lauren M. Postlewait MD, David A. Kooby MD, Maria C. Russell MD, Charles A. Staley MD, Shishir K. Maithel MD & Kenneth Cardona MD

  2. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD & David J. Worhunsky MD

  3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD, Alexandra W. Acher BS, Clifford S. Cho MD & Emily R. Winslow MD

  4. Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Mark Bloomston MD, Carl R. Schmidt MD & Neil Saunders MD

  5. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Linda X. Jin MD

  6. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD & Aslam Ejaz MD

  7. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD, PhD & Douglas S. Swords MD

Authors
  1. Gregory C. Dann BS
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  2. Malcolm H. Squires III MD, MS
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  3. Lauren M. Postlewait MD
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  4. David A. Kooby MD
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  5. George A. Poultsides MD
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  6. Sharon M. Weber MD
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  7. Mark Bloomston MD
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  8. Ryan C. Fields MD
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  9. Timothy M. Pawlik MD, MPH, PhD
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  10. Konstantinos I. Votanopoulos MD, PhD
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  11. Carl R. Schmidt MD
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  12. Aslam Ejaz MD
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  13. Alexandra W. Acher BS
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  14. David J. Worhunsky MD
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  15. Neil Saunders MD
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  16. Douglas S. Swords MD
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  17. Linda X. Jin MD
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  18. Clifford S. Cho MD
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  19. Emily R. Winslow MD
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  20. Maria C. Russell MD
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  21. Charles A. Staley MD
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  22. Shishir K. Maithel MD
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  23. Kenneth Cardona MD
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Corresponding author

Correspondence to Kenneth Cardona MD.

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Dann, G.C., Squires, M.H., Postlewait, L.M. et al. Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma: A Multi-institutional Analysis from the US Gastric Cancer Collaborative. Ann Surg Oncol 22 (Suppl 3), 888–897 (2015). https://doi.org/10.1245/s10434-015-4636-7

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  • DOI: https://doi.org/10.1245/s10434-015-4636-7

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