Upper G.I. Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
Upper G.I. Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
Eur J Surg Oncol. 2020 Aug;46(8):1396-1403. doi: 10.1016/j.ejso.2020.05.009. Epub 2020 May 15.
Prophylactic drain in gastrectomy for cancer is still widely used, although some evidence has disputed this practice and spreading enhanced recovery protocol has been pushing towards surgical simplification. This study aimed at assessing the impact of drain placement on important clinical outcomes, evaluating the results of randomised controlled trials (RCTs), or cohort studies whenever information provided by the former was scarce. PubMed, PMC, Cochrane Library, CNKI and Wanfang databases were searched from January 1990 to February 2019, both for RCTs and cohort studies comparing use or avoidance of prophylactic drain in gastric cancer patients undergoing gastrectomy. All RCTs and cohort studies were rated according to Jadad score and Newcastle-Ottawa-Scale, respectively. Meta-analysis was separately performed on RCTs and cohort studies. The following clinical outcomes were considered: anastomotic leak, reoperation rate, additional drain procedure, length of stay, postoperative morbidity, postoperative mortality, readmission rate and drain related complications. Overall, 3 RCTs (330 patients) and 7 cohort studies (2897 patients) were included. Seven studies came from Eastern Countries. Meta-analysis on RCTs evidenced that drain avoidance halves overall morbidity (RR = 0.47, 95%CI 0.26-0.86, p = 0.014) and slightly reduces length of stay (SMD -0.24, 95%CI -0.51-0.03, p = 0.083). Only one postoperative death occurred in the drain group. The other outcomes were either not reported or reported just by one RCT each. Meta-analysis on cohort studies, despite higher statistical power, did not highlight any significant difference. This meta-analysis showed that prophylactic drain avoidance can reduce morbidity and length of stay, while not significantly affecting other major surgical outcomes.
预防性引流在胃癌手术中仍被广泛应用，尽管一些证据对此做法提出了质疑，且加速康复方案的推广促使手术更加简化。本研究旨在评估引流放置对重要临床结局的影响，评估随机对照试验（RCT）或队列研究的结果，在前者信息稀缺时则评估后者的结果。从 1990 年 1 月至 2019 年 2 月，我们检索了 PubMed、PMC、Cochrane Library、CNKI 和万方数据库，纳入比较胃癌患者行胃切除术后使用与不使用预防性引流的 RCT 和队列研究。所有 RCT 和队列研究均按照 Jadad 评分和 Newcastle-Ottawa 量表进行评分。分别对 RCT 和队列研究进行荟萃分析。考虑的临床结局包括吻合口漏、再次手术率、附加引流操作、住院时间、术后并发症发生率、术后死亡率、再入院率和引流相关并发症。共纳入 3 项 RCT（330 例患者）和 7 项队列研究（2897 例患者）。7 项研究来自东方国家。RCT 荟萃分析表明，引流避免可使总体并发症发生率减半（RR=0.47，95%CI 0.26-0.86，p=0.014），并略微缩短住院时间（SMD-0.24，95%CI-0.51-0.03，p=0.083）。引流组仅发生 1 例术后死亡。其他结局要么未报告，要么仅由 1 项 RCT 报告。尽管队列研究的统计学效能更高，但荟萃分析并未显示出任何显著差异。本荟萃分析表明，预防性引流避免可降低并发症发生率和住院时间，而不会显著影响其他主要手术结局。
