Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
College of Medicine, University of Kentucky, 800 Rose Street, Lexington, KY, 40506, USA.
World J Urol. 2020 Aug;38(8):1905-1917. doi: 10.1007/s00345-019-02978-2. Epub 2019 Oct 29.
To systematically analyze the impact of prophylactic abdominal or retroperitoneal drain placement or omission in uro-oncologic surgery.
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.
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.
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.
系统分析在泌尿生殖系统肿瘤手术中预防性放置或不放置腹部或腹膜后引流管的影响。
本系统评价遵循 Cochrane 建议，并按照 PRISMA 和 AMSTAR-II 标准进行。根据 PICO 标准，对包括 Medline、Web-of-Science 和 CENTRAL 在内的综合数据库进行了全面检索。所有审查步骤均由两名独立审查员完成。使用 Cochrane 随机试验工具和纽卡斯尔-渥太华量表评估偏倚风险。
搜索共确定了 3427 项研究，其中 11 项符合定性分析标准，10 项符合定量分析标准，共纳入 3664 名患者。6 项研究涉及根治性前列腺切除术（RP），4 项研究涉及部分肾切除术（PN），1 项研究涉及根治性膀胱切除术。对于 RP，不引流可降低术后并发症（比值比（OR）[95%置信区间（CI）]：0.62[0.44；0.87]，p=0.006），但再干预（OR[CI]：0.72[0.39；1.33]，p=0.300）、淋巴囊肿（OR[CI]：0.60[0.22；1.60]，p=0.310）、血肿（OR[CI]：0.68[0.18；2.53]，p=0.570）或尿潴留（OR[CI]：0.57[0.26；1.29]，p=0.180）的差异无统计学意义。对于 PN，总并发症（OR[CI]：0.99[0.65；1.51]，p=0.960）或再干预（OR[CI]：1.16[0.31；4.38]，p=0.820）差异无统计学意义。对于 RC，所有参数均无差异。总体证据质量评估为低。
对于标准化的 RP 和 PN 病例，可以推荐不放置引流管。然而，偏离标准仍可能需要放置引流管，这取决于术者的偏好。对于 RC，目前几乎没有证据支持不放置引流管，未来的研究应重点关注这一问题。
审查注册号（PROSPERO）：CRD42019122885。
