Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56 Rozzano, 20089, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy.
Int J Colorectal Dis. 2024 Jul 15;39(1):109. doi: 10.1007/s00384-024-04681-0.
Recent evidence has questioned the usefulness of anastomotic drain (AD) after low anterior resection (LAR). However, the implementation and adoption of a no-drain policy are still poor. This study aims to assess the clinical outcomes of the implementation of a no-drain policy for rectal cancer surgery into a real-life setting and the adherence of the surgeons to such policy.
A retrospective analysis was conducted on patients who underwent elective minimally invasive LAR between January 2015 and December 2019 at two tertiary referral centers. In 2017, both centers implemented a policy aimed at reducing the use of AD. Patients were retrospectively categorized into two groups: the drain policy (DP) group, comprising patients treated before 2017, and the no-drain policy (NDP) group, consisting of patients treated from 2017 onwards. The endpoints were the rate of anastomotic leak (AL) and of related interventions.
Among the 272 patients included, 188 (69.1%) were in the NDP group, and 84 (30.9%) were in the DP group. Baseline characteristics were similar between the two groups. AL rate was 11.2% in the NDP group compared to 10.7% in the DP group (p = 1.000), and the AL grade distribution (grade A, 19.1% (4/21) vs 28.6% (2/9); grade B, 28.6% (6/21) vs 11.1% (1/9); grade C, 52.4% (11/21) vs 66.7% (6/9), p = 0.759) did not significantly differ between the groups. All patients with symptomatic AL and AD underwent surgical treatment for the leak, while those with symptomatic AL in the NPD group were managed with surgery (66.7%), endoscopic (19.0%), or percutaneous (14.3%) interventions. Postoperative outcomes were similar between the groups. Three years after implementing the no-drain policy, AD was utilized in only 16.5% of cases, compared to 76.2% at the study's outset.
The introduction of a no-drain policy received a good adoption rate and did not affect negatively the surgical outcomes.
最近的证据质疑了低位前切除术（LAR）后使用吻合口引流管（AD）的有用性。然而，无引流管政策的实施和采用仍然很差。本研究旨在评估在真实环境中实施直肠癌手术无引流管政策的临床效果以及外科医生对该政策的遵守情况。
对 2015 年 1 月至 2019 年 12 月在两家三级转诊中心接受微创 LAR 的患者进行回顾性分析。2017 年，两家中心都实施了一项旨在减少 AD 使用的政策。患者被回顾性分为两组：引流管政策（DP）组，包括 2017 年之前治疗的患者；无引流管政策（NDP）组，包括 2017 年以后治疗的患者。终点是吻合口漏（AL）的发生率和相关干预措施。
在 272 例患者中，188 例（69.1%）在 NDP 组，84 例（30.9%）在 DP 组。两组的基线特征相似。NDP 组的 AL 发生率为 11.2%，与 DP 组的 10.7%（p=1.000）相比无显著差异，AL 分级分布（A级，19.1%（4/21）vs 28.6%（9/32）；B 级，28.6%（6/21）vs 11.1%（9/82）；C 级，52.4%（11/21）vs 66.7%（9/13），p=0.759）无显著差异。所有有症状的 AL 和 AD 的患者均接受手术治疗，而 NPD 组中出现有症状 AL 的患者则接受手术（66.7%）、内镜（19.0%）或经皮（14.3%）治疗。两组术后结局相似。实施无引流管政策 3 年后，AD 的使用率仅为 16.5%，而研究开始时为 76.2%。
无引流管政策的引入得到了很好的采用，并未对手术结果产生负面影响。
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