Do All Patients Require Prophylactic Drainage After Gastrectomy for Gastric Cancer? The Experience of a High-Volume Center

Lee, Janghee; Choi, Yoon Young; An, Ji Yeong; Seo, Sang Hyuk; Kim, Dong Wook; Seo, Yu Bin; Nakagawa, Masatoshi; Li, Shuangxi; Cheong, Jae‐Ho; Hyung, Woo Jin; Noh, Sung Hoon

doi:10.1245/s10434-015-4521-4

Cited by 26 publications

(21 citation statements)

References 16 publications

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“…Unfortunately, we found no other new RCT nor meta‐analyses concerning abdominal drain placement after gastrectomy. Although we did find several retrospective analysis papers published after 2014, they all suggested that abdominal drain placement was unnecessary or only necessary in high‐risk cases …”

Section: Consensus Guidelines For Enhanced Recovery After Gastrectomymentioning

confidence: 88%

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Yamagata

Yoshikawa

Yura

et al. 2019

Annals of Gastroent Surgery

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Since the late 1990s, perioperative care through the enhanced recovery after surgery (ERAS, European Society for Clinical Nutrition and Metabolism [ESPEN]) program has spread. ERAS protocols aim to reduce surgical complications, improving postoperative outcomes and thereby saving resources by addressing various clinical elements through a multidisciplinary approach or based on evidence. In the field of gastric cancer, the philosophy of ERAS has gradually become accepted and, in 2014, consensus guidelines for enhanced recovery after gastrectomy were published. These guidelines consist of “procedure‐specific” guidelines and “general (not procedure‐specific) enhanced recovery items.” In this review, we focused on the procedure‐specific guidelines and tried to update the contents of every element of the procedure‐specific guidelines. The procedure‐specific guidelines consist of the following eight elements: “Preoperative nutrition,” “Preoperative oral pharmaconutrition,” “Access (of gastrectomy),” “Wound catheters and transversus abdominis plane block,” “Nasogastric/Nasojejunal decompression,” “Perianastomotic drains,” “Early postoperative diet and artificial nutrition,” and “Audit.” On reviewing papers supporting these elements, it was reconfirmed that the recommendations of the guidelines are pertinent and valid. Four meta‐analyses concerning the evaluation of ERAS protocols for gastric cancer were included in this review. Every study showed that the ERAS protocol reduced the cost and duration of hospital stay without increasing surgical complication rates, suggesting that ERAS is effective for gastric cancer surgery. However, it cannot be said that ERAS has achieved full penetration in Japan because most evidence is established in Western countries. Future studies must focus on developing a new ERAS protocols appropriate to Japanese conditions of gastric cancer.

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Section: Consensus Guidelines For Enhanced Recovery After Gastrectomymentioning

confidence: 88%

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Yamagata

Yoshikawa

Yura

et al. 2019

Annals of Gastroent Surgery

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“…The use of abdominal drains following gastrectomy still remains controversial. Prophylactic peritoneal drainage has been widely used during gastrointestinal surgery because of several advantages such as removing intraperitoneal fluid and assisting the early detection of postoperative hemorrhage or anastomotic leakage [ 31 – 33 ]. However, peritoneal drainage can cause uncomfortable which may limit early mobilization and postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials

Wang

et al. 2017

World J Surg Onc

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BackgroundThis meta-analysis is aimed to evaluate the feasibility and safety of enhanced recovery after surgery (ERAS) programs in gastric cancer patients undergoing laparoscopy-assisted gastrectomy (LAG).MethodsWe performed a meta-analysis of randomized control trials involving either enhanced recovery after surgery (ERAS)/fast track surgery (FTS) for patients underwent LAG. EMBASE, Pubmed, Web of science, and Cochrane Library were searched. Primary outcomes included the length of postoperative hospital stay, cost of hospitalization, postoperative complications, and readmission rate.ResultsFive randomized control trials were eligible for analysis. There were 159 cases in FTS group and 156 cases in conventional care group. Compared with conventional care group, FTS group relates to shorter postoperative hospital stay (WMD − 2.16; 95% CI − 3.05 to − 1.26, P < 0.00001), less cost of hospitalization (WMD − 4.72; 95% CI − 6.88 to − 2.55, P < 0.00001), shorter time to first flatus (WMD − 9.72; 95% CI − 13.75 to − 5.81, P < 0.00001), lower level of C-reaction protein on postoperative days 3 or 4 (WMD − 19.66; 95% CI − 28.98 to − 10.34, P < 0.00001), higher level of albumin on postoperative day 4 (WMD 3.45; 95% CI 2.01 to 4.89, P < 0.00001), and postoperative day 7 (WMD 5.63; 95% CI 1.01 to 10.24, P = 0.02). Regarding postoperative complications, no significant differences were observed between FTS group and conventional care group (OR 0.63, 95% CI 0.37 to 1.09, P = 0.10). The readmission rate of FTS group was comparable to conventional care group (WMD 3.14; 95% CI 0.12 to 81.35, P = 0.49).ConclusionsAmong patients undergoing LAG, FTS is associated with shorter postoperative hospital stay, rapid postoperative recovery, and decreased cost without increasing complications or readmission rate. The combined effects of the two methods could further accelerate clinical recovery of gastric cancer patients.

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“…Although avoiding the use of abdominal drains is recommended in the guidelines for ERAS after gastrectomy, 22 the risk of percutaneous abdominal drainage may be increased without abdominal drain insertion. 33 In addition, abdominal drain placement following gastrectomy may not affect the length of hospital stay, 34 suggesting that it is not necessary to avoid using an abdominal drain. Prospective randomized studies providing high-quality evidence should evaluate the significance of abdominal drains following gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

Roh

Son

Lee

et al. 2020

Journal of Surgical Oncology

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Background We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. Methods We performed a prospective, single‐center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. Results Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P < .001) and lower hospital costs ($7771 vs 8539; P < .001) in the ERAS CP group compared with the conventional CP group. Conclusions An ERAS CP can be safely and effectively adopted for patients with gastric cancer without increasing the complication rate and could shorten hospital stays. Trial Registration http://ClinicalTrials.gov (NCT01642953).

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Do All Patients Require Prophylactic Drainage After Gastrectomy for Gastric Cancer? The Experience of a High-Volume Center

Abstract: Not using a PD increased the risk of PCD postoperatively, but no microbes in peritoneal fluid were detected in the most patients. Selective use of PD in patients during gastric cancer surgery may be possible using our risk factor analysis.

Cited by 26 publications

References 16 publications

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials

Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

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