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Meta-Analysis
. 2015 May 11;2015(5):CD008788.
doi: 10.1002/14651858.CD008788.pub3.

Abdominal drainage versus no drainage post-gastrectomy for gastric cancer

Zhen Wang  1 , Junqiang Chen, Ka Su, Zhiyong Dong
Affiliations
Meta-Analysis

Abdominal drainage versus no drainage post-gastrectomy for gastric cancer

Zhen Wang et al. Cochrane Database Syst Rev. .

Abstract

Background: Gastrectomy remains the primary therapeutic method for resectable gastric cancer. Thought of as an important measure to reduce post-operative complications and mortality, abdominal drainage has been used widely after gastrectomy for gastric cancer in previous decades. The benefits of abdominal drainage have been questioned by researchers in recent years.

Objectives: The objectives of this review were to assess the benefits and harms of routine abdominal drainage post-gastrectomy for gastric cancer.

Search methods: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2014, Issue 11); MEDLINE (via PubMed) (1950 to November 2014); EMBASE (1980 to November 2014); and the Chinese National Knowledge Infrastructure (CNKI) Database (1979 to November 2014).

Selection criteria: We included randomised controlled trials (RCTs) comparing an abdominal drain versus no drain in patients who had undergone gastrectomy (not considering the scale of gastrectomy and the extent of lymphadenectomy); irrespective of language, publication status, and the type of drain. We excluded RCTs comparing one drain with another.

Data collection and analysis: We adhered to the standard methodological procedures of The Cochrane Collaboration. From each included trial, we extracted the data on the methodological quality and characteristics of the participants, mortality (30-day mortality), re-operations, post-operative complications (pneumonia, wound infection, intra-abdominal abscess, anastomotic leak, drain-related complications), operation time, length of post-operative hospital stay, and initiation of a soft diet. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous data, we calculated mean difference (MD) and 95% CI. We tested heterogeneity using the Chi(2) test. We used a fixed-effect model for data analysis with RevMan software, but we used a random-effects model if the P value of the Chi(2) test was less than 0.1.

Main results: We included four RCTs involving 438 patients (220 patients in the drain group and 218 in the no-drain group). There was no evidence of a difference between the two groups in mortality (RR 1.73, 95% CI 0.38 to 7.84); re-operations (RR 2.49, 95% CI 0.71 to 8.74); post-operative complications (pneumonia: RR 1.18, 95% CI 0.55 to 2.54; wound infection: RR 1.23, 95% CI 0.47 to 3.23; intra-abdominal abscess: RR 1.27, 95% CI 0.29 to 5.51; anastomotic leak: RR 0.93, 95% CI 0.06 to 14.47); or initiation of soft diet (MD 0.15 days, 95% CI -0.07 to 0.37). However, the addition of a drain prolonged the operation time (MD 9.07 min, 95% CI 2.56 to 15.57) and post-operative hospital stay (MD 0.69 day, 95% CI 0.18 to 1.21) and led to drain-related complications. Additionally, we should note that 30-day mortality and re-operations are very rare events and, as a result, very large numbers of patients would be required to make any sensible conclusions about whether the two groups were similar. The overall quality of the evidence according to the GRADE approach was 'very low' for mortality and re-operations, and 'low' for post-operative complications, operation time, and post-operative length of stay.

Authors' conclusions: We found no convincing evidence to support routine drain use after gastrectomy for gastric cancer.

PubMed Disclaimer

Conflict of interest statement

ZW: none known

JC: none known

KS: none known

ZD: none known

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Drain versus no drain, Outcome 1 30‐day mortality.
1.2
1.2. Analysis
Comparison 1 Drain versus no drain, Outcome 2 Re‐operations.
1.3
1.3. Analysis
Comparison 1 Drain versus no drain, Outcome 3 Pneumonia.
1.4
1.4. Analysis
Comparison 1 Drain versus no drain, Outcome 4 Wound infection.
1.5
1.5. Analysis
Comparison 1 Drain versus no drain, Outcome 5 Intra‐abdominal abscess.
1.6
1.6. Analysis
Comparison 1 Drain versus no drain, Outcome 6 Anastomotic leak.
1.7
1.7. Analysis
Comparison 1 Drain versus no drain, Outcome 7 Operation time.
1.8
1.8. Analysis
Comparison 1 Drain versus no drain, Outcome 8 Length of post‐operative hospital stay.
1.9
1.9. Analysis
Comparison 1 Drain versus no drain, Outcome 9 Initation of soft diet.
See this image and copyright information in PMC

Update of

References

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