Musser John E, Assel Melissa, Guglielmetti Giuliano B, Pathak Prachee, Silberstein Jonathan L, Sjoberg Daniel D, Bernstein Melanie, Laudone Vincent P
1 Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center , New York, New York.
J Endourol. 2014 Nov;28(11):1333-7. doi: 10.1089/end.2014.0268. Epub 2014 Jul 24.
To assess the impact of eliminating routine drain placement in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND) on the risk of postoperative complications.
An experienced single surgeon performed RALP on 651 consecutive patients at our institution from 2008 to 2012. Before August 2011, RALP with or without PLND included a routine peritoneal drain placed during surgery. Thereafter, routine intraoperative placement of drains was omitted, except for intraoperatively noted anastomotic leakage. We used multivariable logistic regression to compare complication rates between study periods and the actual drain placement status after adjusting for standard prespecified covariates.
Most patients (92%) did not have ≥grade 2 complications after surgery and only two patients (0.3%) experienced a grade 4 complication. The absolute adjusted risk of a grade 2-5 complication was 0.9% greater among those treated before August 2011 (95% confidence interval [CI] -3.3%-5.1%; p=0.7), while absolute adjusted risk of a grade 3-5 complication was 2.8% less (-2.8%; 95% CI-5.3%-0.1%; p=0.061). RESULTS based on drain status were similar.
Routine peritoneal drain placement following RALP with PLND did not confer a significant advantage in terms of postoperative complications. Further data are necessary to confirm that it is safe to omit drains in most patients.
评估在接受机器人辅助腹腔镜前列腺切除术（RALP）和盆腔淋巴结清扫术（PLND）的患者中取消常规引流管放置对术后并发症风险的影响。
2008年至2012年，一位经验丰富的外科医生在我们机构为651例连续患者实施了RALP。2011年8月之前，无论是否进行PLND，RALP手术中均常规放置腹腔引流管。此后，除术中发现吻合口漏外，术中不再常规放置引流管。我们使用多变量逻辑回归，在调整标准预设协变量后，比较研究期间的并发症发生率以及实际引流管放置情况。
大多数患者（92%）术后未发生≥2级并发症，仅有2例患者（0.3%）发生4级并发症。2011年8月之前接受治疗的患者发生2 - 5级并发症的绝对调整风险高0.9%（95%置信区间[CI] -3.3% - 5.1%；p = 0.7），而发生3 - 5级并发症的绝对调整风险低2.8%（-2.8%；95% CI -5.3% - 0.1%；p = 0.061）。基于引流管放置情况的结果相似。
RALP联合PLND术后常规放置腹腔引流管在术后并发症方面并无显著优势。需要更多数据来证实大多数患者省略引流管是安全的。
