Necessity of prophylactic drainage tube in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy: A matched‐pair analysis

Abstract

Objectives To assess the necessity of prophylactic drain placement in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy for upper tract urothelial cancer. Methods Between July 2011 and March 2021, 200 patients with localized clinical Tis‐T3 upper urinary tract urothelial carcinoma underwent laparoscopic nephroureterectomy with open distal ureterectomy. After removing the specimen, drainage tubes were placed on the renal beds and/or in the retrovesical spaces. Drain tubes were omitted for most patients after 2017. We compared the postoperative outcomes between the patients with drain placement (D+ group) and without drain placement (D− group) using propensity score matching. Results A total of 164 patients (90 in the D+ group and 74 in the D− group) were enrolled, and matched pairs of 108 patients were analyzed. There was no significant difference in the incidence of complications according to Clavien–Dindo grade in the two groups after the propensity score matching. There was no significant difference in the incidence of postoperative lymphocele (n = 5 vs. 9, p = 0.395) and symptomatic lymphocele (n = 1 vs. 1, p = 1) between the two groups. The length of hospital stay was significantly shorter in the D− group (11 vs. 8 days, p < 0.0001). Conclusions We found that omitting the drainage tube after laparoscopic radical nephroureterectomy did not increase postoperative complications or lymphocele and shortened the post‐hospital stay.

Response to necessity of prophylactic drainage tube in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy: A matched‐pair analysis

“…But we are agreeing with the authors' another opinion, in some cases it is better to place a drain if there is an intraoperative bowel injury, rupture of infected urine into the abdominal cavity, or post-radiotherapy to the bladder. 1 Finally, we believe that the drainage tube should be indwelled in cases of suspected bleeding, intestinal injury. For all cases, indwelling drainage tube is recommended for unexpecting complications, maintaining the intraperitoneal portion of drainage tube at the proper location, 2 and removing the drainage tube according to the amount and nature of the drainage as early as possible.…”

“…For all cases, indwelling drainage tube is recommended for unexpecting complications, maintaining the intraperitoneal portion of drainage tube at the proper location, 2 and removing the drainage tube according to the amount and nature of the drainage as early as possible. 1 Minxiong Hu M.M. 1,2 , Qingguo Zhu M.M.…”