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To Drain or Not to Drain Infraperitoneal Anastomosis After Rectal Excision for Cancer: The GRECCAR 5 Randomized Trial
Quentin Denost1, Philippe Rouanet, Jean-Luc Faucheron
1*Colorectal Unit, Haut Lévêque Hospital, CHU Bordeaux, France †University of Bordeaux, Bordeaux, France ‡Surgical Oncology Department, Montpellier Cancer Institute (ICM), Val d'Aurelle, Montpellier, France §Colorectal Unit, Department of Surgery, Michallon University Hospital, Grenoble, France ¶University Grenoble Alpes, Grenoble, France ||Department of Colorectal Surgery, Beaujon Hospital (AP-HP), Paris VII University, Clichy, France **Department of Surgery, Pontchaillou University Hospital, Rennes, France ††Department of Digestive Surgery, Hospital Center Lyon-Sud, University of Lyon, Lyon, France ‡‡Department of Surgery, Hotel Dieu University Hospital, Nantes, France §§Department of Surgery, Purpan University Hospital, Toulouse, France ¶¶Department of Digestive and Oncological Surgery, Amiens Picardie University Hospital, Amiens, France ||||Inserm Unit, Picardie Jules-Verne University, Amiens, France ***Department of Digestive Surgery, Saint-Joseph Hospital, Paris, France †††Department of Surgery, Bicêtre University Hospital (AP-HP), Le Kremlin-Bicêtre cedex, France ‡‡‡Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, UniversityLille, Lille, France §§§Department of General and Digestive Surgery, University of Aix Marseille, Marseille, France ¶¶¶Department of Digestive and Oncological Surgery, Paoli-Calmettes Institute, Marseille, France ||||||Department of Digestive Surgery, Beauvais Hospital, Beauvais, France ****Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France ††††Department of Digestive Surgery, University Hospital of Poitiers, Poitiers, France ‡‡‡‡Medical Information Department, USMR, CHU de Bordeaux-Public health pole, Bordeaux, France §§§§INSERM, ISPED, INSERM Center U897-Epidemiology-Biostatistic, Bordeaux, France ¶¶¶¶ISPED, INSERM U897 Center-Epidemiology-Biostatistic, University Bordeaux, Bordeaux, France.
Objective:
To assess the effect of pelvic drainage after rectal surgery for cancer.
Background:
Pelvic sepsis is one of the major complications after rectal excision for rectal cancer. Although many studies have confirmed infectiveness of drainage after colectomy, there is still a controversy after rectal surgery.
Methods:
This multicenter randomized trial with 2 parallel arms (drain vs no drain) was performed between 2011 and 2014. Primary endpoint was postoperative pelvic sepsis within 30 postoperative days, including anastomotic leakage, pelvic abscess, and peritonitis. Secondary endpoints were overall morbidity and mortality, rate of reoperation, length of hospital stay, and rate of stoma closure at 6 months.
Results:
A total of 494 patients were randomized, 25 did not meet the criteria and 469 were analyzed: 236 with drain and 233 without. The anastomotic height was 3.5 ± 1.9 cm from the anal verge. The rate of pelvic sepsis was 17.1% (80/469) and was similar between drain and no drain: 16.1% versus 18.0% (P = 0.58). There was no difference of surgical morbidity (18.7% vs 25.3%; P = 0.83), rate of reoperation (16.6% vs 21.0%; P = 0.22), length of hospital stay (12.2 vs 12.2; P = 0.99) and rate of stoma closure (80.1% vs 77.3%; P = 0.53) between groups. Absence of colonic pouch was the only independent factor of pelvic sepsis (odds ratio = 1.757; 95% confidence interval 1.078-2.864; P = 0.024).
Conclusions:
This randomized trial suggests that the use of a pelvic drain after rectal excision for rectal cancer did not confer any benefit to the patient.
