回顾直肠癌低位前切除术后引流管的价值：996 例多机构分析。
Revisiting the Value of Drains After Low Anterior Resection for Rectal Cancer: a Multi-institutional Analysis of 996 Patients.
机构信息
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Gastrointest Surg. 2021 Aug;25(8):2000-2010. doi: 10.1007/s11605-020-04781-6. Epub 2020 Aug 31.
BACKGROUND
Intraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was to assess the validity of this practice.
METHODS
Patients from the US Rectal Cancer Consortium (2007-2017) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection (SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low anastomoses < 6 cm from the anal verge.
RESULTS
Of 996 patients 67% (n = 551) received a drain. Drain patients were more likely to be male (64 vs 54%), have a smoking history (25 vs 19%), have received neoadjuvant chemoradiation (73 vs 61%), have low tumors (56 vs 36%), and have received a DLI (80 vs 71%) (all p < 0.05). Drains were associated with an increased anastomotic leak rate (14 vs 8%, p = 0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82 vs 88%, p = 0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12 vs 10%, p = 0.478) and readmission rates (28 vs 31%, p = 0.511) were similar.
CONCLUSIONS
Although not associated with increased infectious complications, intraoperatively placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage appears to be unnecessary.
背景
在低位前切除术（LAR）期间，通常会放置盆腔引流管以排出术后积液并识别/控制潜在的吻合口漏。我们的目的是评估这种做法的有效性。
方法
该研究纳入了美国直肠肿瘤联盟（2007-2017 年）接受根治性 LAR 治疗原发性直肠癌的患者。患者分为术中接受闭式引流和未接受引流。主要结局为浅表手术部位感染（SSI）、深部 SSI、腹腔脓肿、吻合口漏和需要二次引流。在接受新辅助放化疗、使用预防性回肠造口术（DLI）和吻合口位置低于肛缘<6cm 的患者中进行了三项亚组分析。
结果
在 996 例患者中，67%（n=551）接受了引流。引流组患者更可能为男性（64% vs 54%）、有吸烟史（25% vs 19%）、接受了新辅助放化疗（73% vs 61%）、肿瘤位置较低（56% vs 36%）和使用了 DLI（80% vs 71%）（均 p<0.05）。引流与吻合口漏发生率增加相关（14% vs 8%，p=0.041），但控制漏的二次引流术的需求无差异（82% vs 88%，p=0.924）。这些发现在前述所有亚组分析中均成立。引流与整个队列或每个亚组分析中的浅表 SSI、深部 SSI 或腹腔脓肿发生率增加均无关。再次手术率（12% vs 10%，p=0.478）和再入院率（28% vs 31%，p=0.511）相似。
结论
尽管与感染性并发症增加无关，但在低位前切除术后放置盆腔引流管与吻合口漏发生率增加有关，且不能减少对二次引流或再次手术的需求。常规引流似乎没有必要。
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