Abstract
Objectives
We aimed to assess the impact of a postoperative drainage after RPN.
Methods
A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)].
Results
Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (>50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64–1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay.
Conclusion
The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
Similar content being viewed by others
References
Ljungberg B, Bensalah K, Bex A et al (2014) Guidelines on renal cell carcinoma. Uroweb. http://www.uroweb.org/gls/pdf/10_Renal_Cell_Carcinoma_LRV2.pdf
Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46
Kim JH, Park YH, Kim YJ et al (2015) Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison. World J Urol 33:1579–1584
Van Poppel H, DaPozzo L, Albrecht W et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal carcinoma. Eur Urol 51:1606–1615
Stephenson AJ, Hakimi AA, Snyder ME et al (2004) Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 171:130–134
Poon SA, Silberstein JL, Chen LY et al (2013) Trends in partial and radical nephrectomy: an analysis of case logs from certifying urologists. J Urol 190(2):464–469
Nora PF, Vanecko RM, Bransfield JJ (1972) Prophylactic abdominal drains. Arch Surg 105:173
Sánchez-Ortiz R, Madsen LT, Swanson DA et al (2004) Closed suction or penrose drainage after partial nephrectomy: does it matter? J Urol 171(1):244–246
Park JS, Kim JH, Kim JK et al (2015) The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial. Surg Endosc 29(2):453–457
Rondelli F, Desio M, Vedovati MC et al (2014) Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes. Int J Surg 12(Suppl 1):S40–S47
Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Robinson JO (1986) Surgical drainage: a historical perspective. Br J Surg 73:422–426
Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1084
Clements T, Raman JD (2011) Surgery: is perinephric drainage essential after partial nephrectomy? Nat Rev Urol 8(11):594–595
Godoy G, Katz DJ, Adamy A, Jamal JE, Bernstein M, Russo P (2011) Routine drain placement after partial nephrectomy is not always necessary. J Urol 186(2):411–415
Abaza R, Prall D (2013) Drain placement can be safely omitted after the majority of robotic partial nephrectomies. J Urol 189(3):823–827
Campbell SC, Novick AC, Streem SB, Klein E, Licht M (1994) Complications of nephron sparing surgery for renal tumors. J Urol 151(5):1177–1180
Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND (2008) Risk factors and management of urine leaks after partial nephrectomy. J Urol 180(6):2375–2378
Sarwani NI, Motta Ramirez GA, Remer EM, Kaouk JH, Gill IS (2007) Imaging findings after minimally invasive nephron-sparing renal therapies. Clin Radiol 62(4):333–339
Schein M (2008) To drain or not to drain? The role of drainage in the contaminated and infected abdomen: an international and personal perspective. World J Surg 32(2):312–321
Author contributions
Peyronnet, De La Taille, Roupret, Bensalah and Mejean developed the project and protocol. Pradère, Vaessen, Baumert, Bernhard, Doumerc, Droupy and Bruyere contributed to data collection or management. Peyronnet and Bensalah analyzed the data. Peyronnet and Bensalah contributed to manuscript writing/editing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Peyronnet, B., Pradère, B., De La Taille, A. et al. Postoperative drainage does not prevent complications after robotic partial nephrectomy. World J Urol 34, 933–938 (2016). https://doi.org/10.1007/s00345-015-1721-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-015-1721-2