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Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis

International Journal of Colorectal Disease volume 34, pages 973–981 (2019)Cite this article

Abstract

Objective

The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prophylactic drains in anterior rectal resections.

Methods

A systematic search was conducted of MEDLINE, Scopus, EMBASE, and Cochrane Library databases to identify clinical trials comparing the use of drainage to non-drainage in cases of colorectal anastomosis.

Results

Three randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) were identified that met the inclusion criteria, with a total of 1702 patients with rectal cancer who underwent anterior resection: 1206 with a pelvic drain and 496 without a pelvic drain. Meta-analysis showed that the use of a drain did not significantly improve the outcomes of anastomotic leaks; the overall reoperation rate during the 30-day postoperative period and the postoperative mortality were statistically lower in the drained group (OR 2.82, 95% CI 1.33 to 5.97; I2 = 0%).

Conclusions

The use of prophylactic pelvic drainage after anterior rectal resections does not provide significant benefits with respect to anastomotic leaks and overall complication rates. However, an approximately threefold reduction of the postoperative mortality of the drained patients was observed. Given the limitations of the present study, these findings warrant the use of a drain after anterior rectal resection. Nevertheless, due to the low quality of the available data, further multicenter trials with uniform inclusion criteria are needed to evaluate drain usage in the anterior rectal resection.

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Acknowledgements

Vito D’Andrea, Pietro Ursi, George Mantese, and Alessandro Quintili for the editing and revision

Authorship

All authors made a contribution in the concept and design of the study in addition to the collection, analysis, writing, and editing of data. All authors approved the manuscript.

Author information

Affiliations

  1. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy

    Davide Cavaliere, Giorgio Ercolani & Leonardo Solaini

  2. Military Medical Academy, ul. “Sveti Georgi Sofiyski” 3, Sofia Center, 1606, Sofia, Bulgaria

    Georgi Popivanov

  3. Department of Minimally-Invasive and General Surgery, Policlinico Abano Terme, Piazza Cristoforo Colombo, 1, 35031, Abano Terme, Padova, Italy

    Diletta Cassini

  4. Department of Surgical Science, University of Perugia, Perugia, Italy

    Roberto Cirocchi

  5. International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland

    Brandon M. Henry & Krzysztof Andrzej Tomaszewski

  6. Laparoscopic Surgery Unit, Department of Surgery, M Mellini Hospital, Viale Mazzini, 4, 25032, Chiari, Brescia, Italy

    Nereo Vettoretto

  7. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy

    Giorgio Ercolani & Leonardo Solaini

  8. IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, Via Giuseppe La Masa, 19, 20156, Milan, Italy

    Chiara Gerardi

  9. Clinic of Surgery, University Hospital for Active Treatment, “St. Ivan Rilski”, Sofia, Bulgaria

    Mihail Tabakov

  10. Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland

    Krzysztof Andrzej Tomaszewski

Authors
  1. Davide Cavaliere
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  2. Georgi Popivanov
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  3. Diletta Cassini
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  4. Roberto Cirocchi
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  5. Brandon M. Henry
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  7. Giorgio Ercolani
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  8. Leonardo Solaini
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  9. Chiara Gerardi
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  11. Krzysztof Andrzej Tomaszewski
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Correspondence to Roberto Cirocchi.

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Cavaliere, D., Popivanov, G., Cassini, D. et al. Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. Int J Colorectal Dis 34, 973–981 (2019). https://doi.org/10.1007/s00384-019-03276-4

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  • DOI: https://doi.org/10.1007/s00384-019-03276-4

Keywords

  • Drain
  • Rectal cancer
  • Anterior rectal resection