Journal Article

Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma: A Multi-institutional Analysis from the US Gastric Cancer Collaborative

Cardona, Kenneth, Dann, Gregory C., Bloomston, Mark, Pawlik, Timothy M., Swords, Douglas S., Schmidt, Carl R., Squires, Malcolm H., Kooby, David A., Staley, Charles A., Russell, Maria C., Winslow, Emily R., Jin, Linda X., Cho, Clifford S., Fields, Ryan C., Weber, Sharon M., Ejaz, Aslam, Saunders, Neil, Maithel, Shishir K., Poultsides, George A., Acher, Alexandra W., Worhunsky, David J., Postlewait, Lauren M., Votanopoulos, Konstantinos I.

2015

Overview

Background The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established. Methods Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified. The association of PD placement with postoperative outcomes was analyzed. Results Overall, 344 patients were identified and 253 (74 %) patients received a PD. The anastomotic leak rate was 9 %. Those with PD placement had similar American Society of Anesthesiologists score, tumor size, TNM stage, and the need for additional organ resection when compared with their counterparts. No difference was observed in the rate of any complication (54 vs. 48 %; p   =  0.45), major complication (25 vs. 24 %; p   =  0.90), or 30-day mortality (7 vs. 4 %; p   =  0.51) between the two groups. In addition, no difference in anastomotic leak (9 vs. 10 %; p   =  0.90), the need for secondary drainage (10 vs. 9 %; p   =  0.92), or reoperation (13 vs. 8 %; p   =  0.28) was identified. On multivariate analysis, PD placement was not associated with decreased postoperative complications. Subset analysis, stratified by patients who did not undergo concomitant pancreatectomy ( n   =  319) or those who experienced anastomotic leak ( n   =  31), similarly demonstrated no association of PD placement with reduced complications or mortality. Conclusions PD placement after total gastrectomy for GAC is associated with neither a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, nor a decrease in the need for secondary drainage procedures or reoperation. Routine use of PDs is not warranted.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adenocarcinoma - pathology / Adenocarcinoma - surgery / Adult / Aged / Aged, 80 and over / Anastomotic Leak - prevention & control / Drainage - instrumentation / Drainage - methods / Female / Follow-Up Studies / Gastrectomy - adverse effects / Gastrointestinal Oncology / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Grading / Neoplasm Staging / Oncology / Postoperative Complications / Prognosis / Reoperation / Retrospective Studies / Stomach Neoplasms - pathology / Stomach Neoplasms - surgery / Surgery / Surgical Oncology / Survival Rate / United States / Young Adult