Prophylactic Drain Placement and Postoperative Invasive Procedures After Gastrectomy: The Abdominal Drain After...

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Trials

Background:

• Prophylactic abdominal drainage after gastrectomy for cancer is debated, with small studies showing potential benefits but carrying a high risk of bias.
• Further research is needed to confirm if drains effectively identify and manage postoperative intraperitoneal collections, potentially avoiding reoperation or percutaneous drainage.

Purpose of the Study:

• To determine if avoiding routine abdominal drainage after gastrectomy increases the need for postoperative invasive procedures.

Main Methods:

• A multicenter prospective randomized noninferiority trial (ADIGE Trial) involving 404 patients undergoing gastrectomy for cancer.
• Patients were randomized 1:1 to receive prophylactic abdominal drains or no drains.
• The primary endpoint was reoperation or percutaneous drainage within 30 days, analyzed using a modified intention-to-treat approach.

Main Results:

• The group without drains required significantly more reoperations or percutaneous drainage (15%) compared to the drain group (7.7%), favoring the use of drains.
• The difference in the primary composite endpoint was primarily driven by a higher rate of reoperation in the no-drain group (12.4% vs. 5.1%).
• Drain-related complications were infrequent (4 patients).

Conclusions:

• Avoiding prophylactic abdominal drainage after gastrectomy increases the risk of postoperative invasive procedures, suggesting its continued use is advisable.
• Future research should focus on identifying specific patient subgroups who may benefit most from prophylactic drainage.