Risk factors as criteria for drain use in gastrectomy: A prospective study

Total gastrectomy with D2 lymph node dissection remains the standard treatment option for resectable esophagogastric junctional and gastric cancer; however, high rates of morbidity lead to challenges in perioperative care. The Enhanced Recovery after Surgery (ERAS) guidelines advise against the use of routine drains; yet, conflicting evidence leads to inconsistent use in clinical practice. The Drains After Gastrectomy (DRaG) trial was a prospective, non-randomized study conducted from February 2020 to March 2023 at the Hippocration General Hospital, University of Athens. Patients undergoing open D2 total gastrectomy were treated with perianastomotic drainage based on evidence-based criteria, offering a tailored approach to treatment. Immediate and short-term post-operative outcomes, including complications and key milestones in recovery, were assessed. In total, 60 patients were included in the prospective study, with 40 receiving a drain based on evidence-supported, case-based criteria. The non-drain group exhibited lower pain scores, earlier rates of mobilization, lower levels of post-operative nausea and vomiting, and shorter hospital stays. By contrast, patients presenting with complications experienced a delayed post-operative recovery, which may have been associated with the use of the drain. Although adverse effects are common, the application of specific criteria may aid clinical decision making. In conclusion, the present study aimed to provide a criteria-based approach for individualising drain placement in gastrectomy. Notably, the findings of the present study are comparable with those of existing studies; thus, the suggested criteria offer a structured and reliable approach to the use of drain placement following gastrectomy in surgical practice.