AIM： To determine the evidence-based values of prophylactic drainage in gastric cancer surgery. METHODS： One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gas...AIM： To determine the evidence-based values of prophylactic drainage in gastric cancer surgery. METHODS： One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups. RESULTS： No significant differences were observed between the drain group and no-drain group in terms of operating time （171 ± 42 rain vs 156 ± 39 rain）, number of post-operative days until passage of flatus （3.7 ± 0.5 d vs 3.5 ± 1.0 d）, number of post-operative days until initiation of soft diet （4.9±0.7 d vs 4.8±0.8 d）, length of post-operative hospital stay （9.3±2.2 d vs 8.4±2.4 d）, mortality rate （5.4% vs 3.8%）, and overall postoperative complication rate （21.4% vs 19.2%）. CONCLUSION： Prophylactic drainage placement is not necessary afer subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.展开更多
BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed world...BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed worldwide.However,reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few.AIM To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients.METHODS Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed.The outcomes between patients with and without prophylactic drainage were compared.RESULTS A total of 457 patients who underwent surgery for gastric cancer were identified.Of these,125 patients who underwent totally laparoscopic distal gastrectomy were included.After propensity score matching,data of 42 pairs were extracted.The incidence of concurrent illness was higher in the drain group(42.9%vs 31.0%,P=0.258).The overall postoperative complication rates were 19.5%and 10.6%in the drain(n=76)and no-drain groups(n=49),respectively;there were no significant differences between the two groups(P>0.05).The difference between the two groups based on the need for percutaneous catheter drainage was also not significant(9.8%vs 6.4%,P=0.700).However,patients with a larger body mass index(≥29 kg/m2)were prone to postoperative complications(P=0.042).In addition,the number of days from surgery until the first flatus(4.33±1.24 d vs 3.57±1.85 d,P=0.029)was greater in the drain group.CONCLUSION Omitting prophylactic drainage may reduce surgery time and result in faster recovery.Routine prophylactic drains are not necessary in selected patients.A prophylactic drain may be useful in high-risk patients.展开更多
Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been de...Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than beneficial.Based on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all patients.Herein,we express our opinion regarding this interesting publication.展开更多
Background:Surgeons have placed different number of intraperitoneal drains(IDs)in the absence of a harmonized reference or rationale.This study aims to evaluate whether robotic-assisted pancreaticoduodenectomy(RPD)wit...Background:Surgeons have placed different number of intraperitoneal drains(IDs)in the absence of a harmonized reference or rationale.This study aims to evaluate whether robotic-assisted pancreaticoduodenectomy(RPD)with a 2-drain and an additional inferior pancreaticojejunostomy(PJ)drain strategy reduces the frequency or severity of complications,particularly the rate of postoperative percutaneous drainage.Methods:We collected data from 235 patients of RPD performed by 1 single surgeon with and without the use of extra ID inferior to PJ site and compared the complications between the 2 groups after propensity score matching.Results:RPD with 3 drains showed a lower incidence of postoperative percutaneous drainage(31[35.2%]vs 5[5.7%],P<.001),surgical site infection(SSI)or intra-abdominal fluid collection(46[52.2%]vs 31[35.2%],P=.003),and clinically relevant postoperative pancreatic fistula(CR-POPF;27[30.7%]vs 11[12.5%],P=.006).More than half(48[54.5%])of the patients in 3-drain group had a drainage volume of inferior PJ drainage that consistently exceeded the superior PJ drainage or intermittently exceeded the superior PJ drainage.For those at high risk of pancreatic fistula(International Study Group for Pancreatic Surgery[ISGPS-C]and[ISGPS-D]),3 drains significantly reduced the postoperative percutaneous drainage rate and incidence of SSI or intra-abdominal fluid collection compared to 2 drains.Conclusions:This study suggested that prophylactic placement of additional inferior PJ drain during RPD,in contrast to 2 drains only,significantly reduces the incidence of CR-POPF,SSI or intra-abdominal fluid collection,and postoperative percutaneous drainage.展开更多
文摘AIM： To determine the evidence-based values of prophylactic drainage in gastric cancer surgery. METHODS： One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups. RESULTS： No significant differences were observed between the drain group and no-drain group in terms of operating time （171 ± 42 rain vs 156 ± 39 rain）, number of post-operative days until passage of flatus （3.7 ± 0.5 d vs 3.5 ± 1.0 d）, number of post-operative days until initiation of soft diet （4.9±0.7 d vs 4.8±0.8 d）, length of post-operative hospital stay （9.3±2.2 d vs 8.4±2.4 d）, mortality rate （5.4% vs 3.8%）, and overall postoperative complication rate （21.4% vs 19.2%）. CONCLUSION： Prophylactic drainage placement is not necessary afer subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.
基金Supported by National Natural Science Foundation of China,No.81772642Capital’s Funds for Health Improvement and Research,No.CFH 2018-2-4022.
文摘BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed worldwide.However,reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few.AIM To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients.METHODS Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed.The outcomes between patients with and without prophylactic drainage were compared.RESULTS A total of 457 patients who underwent surgery for gastric cancer were identified.Of these,125 patients who underwent totally laparoscopic distal gastrectomy were included.After propensity score matching,data of 42 pairs were extracted.The incidence of concurrent illness was higher in the drain group(42.9%vs 31.0%,P=0.258).The overall postoperative complication rates were 19.5%and 10.6%in the drain(n=76)and no-drain groups(n=49),respectively;there were no significant differences between the two groups(P>0.05).The difference between the two groups based on the need for percutaneous catheter drainage was also not significant(9.8%vs 6.4%,P=0.700).However,patients with a larger body mass index(≥29 kg/m2)were prone to postoperative complications(P=0.042).In addition,the number of days from surgery until the first flatus(4.33±1.24 d vs 3.57±1.85 d,P=0.029)was greater in the drain group.CONCLUSION Omitting prophylactic drainage may reduce surgery time and result in faster recovery.Routine prophylactic drains are not necessary in selected patients.A prophylactic drain may be useful in high-risk patients.
文摘Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than beneficial.Based on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all patients.Herein,we express our opinion regarding this interesting publication.
基金supported by the National Natural Science Foundation of China(Grant nos.82072644,82203105)The Guangzhou Clinical Major Technical Project(2023P-ZD02).
文摘Background:Surgeons have placed different number of intraperitoneal drains(IDs)in the absence of a harmonized reference or rationale.This study aims to evaluate whether robotic-assisted pancreaticoduodenectomy(RPD)with a 2-drain and an additional inferior pancreaticojejunostomy(PJ)drain strategy reduces the frequency or severity of complications,particularly the rate of postoperative percutaneous drainage.Methods:We collected data from 235 patients of RPD performed by 1 single surgeon with and without the use of extra ID inferior to PJ site and compared the complications between the 2 groups after propensity score matching.Results:RPD with 3 drains showed a lower incidence of postoperative percutaneous drainage(31[35.2%]vs 5[5.7%],P<.001),surgical site infection(SSI)or intra-abdominal fluid collection(46[52.2%]vs 31[35.2%],P=.003),and clinically relevant postoperative pancreatic fistula(CR-POPF;27[30.7%]vs 11[12.5%],P=.006).More than half(48[54.5%])of the patients in 3-drain group had a drainage volume of inferior PJ drainage that consistently exceeded the superior PJ drainage or intermittently exceeded the superior PJ drainage.For those at high risk of pancreatic fistula(International Study Group for Pancreatic Surgery[ISGPS-C]and[ISGPS-D]),3 drains significantly reduced the postoperative percutaneous drainage rate and incidence of SSI or intra-abdominal fluid collection compared to 2 drains.Conclusions:This study suggested that prophylactic placement of additional inferior PJ drain during RPD,in contrast to 2 drains only,significantly reduces the incidence of CR-POPF,SSI or intra-abdominal fluid collection,and postoperative percutaneous drainage.
