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Observational Study
. 2025 Nov 1;111(11):7970-7977.
doi: 10.1097/JS9.0000000000002965. Epub 2025 Jul 7.

Propensity score-matched analysis comparing drains and no-drains in rectal cancer surgery: the value of using a hemostatic agent instead - a prospective observational study

Francisco J Blanco  1 , Jorge Castillo  2 , Sergio Mariner  1 , Mónica Reig  3 , Jose A Robles  3 , Héctor Guadalajara  4 , Miguel León-Arellano  4 , Alicia Ruiz de la Hermosa  5 , Maria L Fuenmayor  5 , Antonio Arroyo  5 , Luis Sánchez-Guillen  6 , María V Duque  7 , María J García-Coret  8 , Celia Baez  8 , Xavier Viñas  9 , Adrián Aurensanz  2 , Zeus Gracia  2 , Jesús Asín  2 , Alejandro Bona  10 , Jose M Ramirez  10
Affiliations
Observational Study

Propensity score-matched analysis comparing drains and no-drains in rectal cancer surgery: the value of using a hemostatic agent instead - a prospective observational study

Francisco J Blanco et al. Int J Surg. .

Abstract

Background: This study evaluates the efficacy of microporous polysaccharide hemospheres (MPH) as an alternative to prophylactic drains in rectal cancer surgery. We hypothesize that MPH reduces postoperative complications by minimizing fluid accumulation and associated risks, thereby improving outcomes within enhanced recovery protocols (ERPs).

Methods: A prospective, multicenter observational study was conducted from January 2020 to January 2024, including adult patients undergoing high or low rectal resection for rectal cancer. Patients receiving MPH were compared to matched controls from the IMPRICA database who either received prophylactic drains or no drainage. Propensity score matching was employed to mitigate selection bias. Outcomes were assessed within the 30 postoperative days, focusing on surgical and medical complications.

Results: From a cohort of 3725 patients, 90 received MPH without drainage, 2806 underwent surgery with prophylactic drains, and 829 had no drains. Between 2020 and 2024, surgical complications were significantly lower in the MPH group (12.2%) compared to the drain group (26.2%) and comparable to the no-drain group (20.6%). The odds of complications in the MPH group were reduced by nearly half with respect to the no-drain group [odds ratio: 0.54 (95% confidence interval: 0.27-1.08)]. MPH was associated with fewer anastomotic leaks, hemorrhages, and surgical site infections, and no adverse effects were reported.

Conclusion: This study provides evidence that prophylactic drains are not only unnecessary but may also be potentially harmful in rectal surgery. The application of MPH offers a safe and effective alternative to improve postoperative outcomes. These findings support a shift toward eliminating drains in favor of innovative solutions aligned with ERP principles.

Keywords: enhanced recovery protocols (ERP); postoperative complications; prophylactic drains; prospective multicenter observational study; rectal surgery.

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Conflict of interest statement

The authors of this study, who are members of the Spanish GERM Scientific Society, wish to declare that this research has been partially funded by BD. While this funding has provided essential support for the project, the authors affirm that it has not influenced the study design, data collection, analysis, interpretation of the data, or the decision to publish the findings. The working group is dedicated to upholding scientific integrity and objectivity throughout the research process.

Figures

Figure 1.
Figure 1.
Patients flow from the full cohort in Group 1 ( n1), Group 3 ( n3), and Group 2 ( n2) to the subjects included in the study.
Figure 2.
Figure 2.
Absolute standardized difference in means (left) and ratio of variances (right) for all covariates, their squares (if continuous), and two-way interactions before and after propensity score-matched Group 3 vs Group 2 (top) and Group 1 vs Group 3 (bottom).
See this image and copyright information in PMC

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