Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma

A Multi-institutional Analysis from the US Gastric Cancer Collaborative

Gregory C. Dann, Malcolm H. Squires, Lauren M. Postlewait, David A. Kooby, George A. Poultsides, Sharon M. Weber, Mark Bloomston, Ryan C. Fields, Timothy M. Pawlik, Konstantinos I. Votanopoulos, Carl R. Schmidt, Aslam Ejaz, Alexandra W. Acher, David J. Worhunsky, Neil Saunders, Douglas S. Swords, Linda X. Jin, Clifford S. Cho, Emily R. Winslow, Maria C. Russell & 3 others Charles A. Staley, Shishir K. Maithel, Kenneth Cardona

Research output: Contribution to journalArticle

Abstract

Background: The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established. Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified. The association of PD placement with postoperative outcomes was analyzed. Results: Overall, 344 patients were identified and 253 (74 %) patients received a PD. The anastomotic leak rate was 9 %. Those with PD placement had similar American Society of Anesthesiologists score, tumor size, TNM stage, and the need for additional organ resection when compared with their counterparts. No difference was observed in the rate of any complication (54 vs. 48 %; p = 0.45), major complication (25 vs. 24 %; p = 0.90), or 30-day mortality (7 vs. 4 %; p = 0.51) between the two groups. In addition, no difference in anastomotic leak (9 vs. 10 %; p = 0.90), the need for secondary drainage (10 vs. 9 %; p = 0.92), or reoperation (13 vs. 8 %; p = 0.28) was identified. On multivariate analysis, PD placement was not associated with decreased postoperative complications. Subset analysis, stratified by patients who did not undergo concomitant pancreatectomy (n = 319) or those who experienced anastomotic leak (n = 31), similarly demonstrated no association of PD placement with reduced complications or mortality. Conclusions: PD placement after total gastrectomy for GAC is associated with neither a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, nor a decrease in the need for secondary drainage procedures or reoperation. Routine use of PDs is not warranted.

Original languageEnglish (US)
Pages (from-to)888-897
Number of pages10
JournalAnnals of Surgical Oncology
Volume22
DOIs
StatePublished - Dec 1 2015

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Anastomotic Leak
Gastrectomy
Stomach Neoplasms
Stomach
Adenocarcinoma
Drainage
Reoperation
Mortality
Pancreatectomy
Multivariate Analysis
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma : A Multi-institutional Analysis from the US Gastric Cancer Collaborative. / Dann, Gregory C.; Squires, Malcolm H.; Postlewait, Lauren M.; Kooby, David A.; Poultsides, George A.; Weber, Sharon M.; Bloomston, Mark; Fields, Ryan C.; Pawlik, Timothy M.; Votanopoulos, Konstantinos I.; Schmidt, Carl R.; Ejaz, Aslam; Acher, Alexandra W.; Worhunsky, David J.; Saunders, Neil; Swords, Douglas S.; Jin, Linda X.; Cho, Clifford S.; Winslow, Emily R.; Russell, Maria C.; Staley, Charles A.; Maithel, Shishir K.; Cardona, Kenneth.

In: Annals of Surgical Oncology, Vol. 22, 01.12.2015, p. 888-897.

Research output: Contribution to journalArticle

Dann, GC, Squires, MH, Postlewait, LM, Kooby, DA, Poultsides, GA, Weber, SM, Bloomston, M, Fields, RC, Pawlik, TM, Votanopoulos, KI, Schmidt, CR, Ejaz, A, Acher, AW, Worhunsky, DJ, Saunders, N, Swords, DS, Jin, LX, Cho, CS, Winslow, ER, Russell, MC, Staley, CA, Maithel, SK & Cardona, K 2015, 'Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma: A Multi-institutional Analysis from the US Gastric Cancer Collaborative', Annals of Surgical Oncology, vol. 22, pp. 888-897. https://doi.org/10.1245/s10434-015-4636-7
Dann, Gregory C. ; Squires, Malcolm H. ; Postlewait, Lauren M. ; Kooby, David A. ; Poultsides, George A. ; Weber, Sharon M. ; Bloomston, Mark ; Fields, Ryan C. ; Pawlik, Timothy M. ; Votanopoulos, Konstantinos I. ; Schmidt, Carl R. ; Ejaz, Aslam ; Acher, Alexandra W. ; Worhunsky, David J. ; Saunders, Neil ; Swords, Douglas S. ; Jin, Linda X. ; Cho, Clifford S. ; Winslow, Emily R. ; Russell, Maria C. ; Staley, Charles A. ; Maithel, Shishir K. ; Cardona, Kenneth. / Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma : A Multi-institutional Analysis from the US Gastric Cancer Collaborative. In: Annals of Surgical Oncology. 2015 ; Vol. 22. pp. 888-897.
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title = "Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma: A Multi-institutional Analysis from the US Gastric Cancer Collaborative",
abstract = "Background: The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established. Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified. The association of PD placement with postoperative outcomes was analyzed. Results: Overall, 344 patients were identified and 253 (74 {\%}) patients received a PD. The anastomotic leak rate was 9 {\%}. Those with PD placement had similar American Society of Anesthesiologists score, tumor size, TNM stage, and the need for additional organ resection when compared with their counterparts. No difference was observed in the rate of any complication (54 vs. 48 {\%}; p = 0.45), major complication (25 vs. 24 {\%}; p = 0.90), or 30-day mortality (7 vs. 4 {\%}; p = 0.51) between the two groups. In addition, no difference in anastomotic leak (9 vs. 10 {\%}; p = 0.90), the need for secondary drainage (10 vs. 9 {\%}; p = 0.92), or reoperation (13 vs. 8 {\%}; p = 0.28) was identified. On multivariate analysis, PD placement was not associated with decreased postoperative complications. Subset analysis, stratified by patients who did not undergo concomitant pancreatectomy (n = 319) or those who experienced anastomotic leak (n = 31), similarly demonstrated no association of PD placement with reduced complications or mortality. Conclusions: PD placement after total gastrectomy for GAC is associated with neither a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, nor a decrease in the need for secondary drainage procedures or reoperation. Routine use of PDs is not warranted.",
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T1 - Value of Peritoneal Drain Placement After Total Gastrectomy for Gastric Adenocarcinoma

T2 - A Multi-institutional Analysis from the US Gastric Cancer Collaborative

AU - Dann, Gregory C.

AU - Squires, Malcolm H.

AU - Postlewait, Lauren M.

AU - Kooby, David A.

AU - Poultsides, George A.

AU - Weber, Sharon M.

AU - Bloomston, Mark

AU - Fields, Ryan C.

AU - Pawlik, Timothy M.

AU - Votanopoulos, Konstantinos I.

AU - Schmidt, Carl R.

AU - Ejaz, Aslam

AU - Acher, Alexandra W.

AU - Worhunsky, David J.

AU - Saunders, Neil

AU - Swords, Douglas S.

AU - Jin, Linda X.

AU - Cho, Clifford S.

AU - Winslow, Emily R.

AU - Russell, Maria C.

AU - Staley, Charles A.

AU - Maithel, Shishir K.

AU - Cardona, Kenneth

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background: The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established. Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified. The association of PD placement with postoperative outcomes was analyzed. Results: Overall, 344 patients were identified and 253 (74 %) patients received a PD. The anastomotic leak rate was 9 %. Those with PD placement had similar American Society of Anesthesiologists score, tumor size, TNM stage, and the need for additional organ resection when compared with their counterparts. No difference was observed in the rate of any complication (54 vs. 48 %; p = 0.45), major complication (25 vs. 24 %; p = 0.90), or 30-day mortality (7 vs. 4 %; p = 0.51) between the two groups. In addition, no difference in anastomotic leak (9 vs. 10 %; p = 0.90), the need for secondary drainage (10 vs. 9 %; p = 0.92), or reoperation (13 vs. 8 %; p = 0.28) was identified. On multivariate analysis, PD placement was not associated with decreased postoperative complications. Subset analysis, stratified by patients who did not undergo concomitant pancreatectomy (n = 319) or those who experienced anastomotic leak (n = 31), similarly demonstrated no association of PD placement with reduced complications or mortality. Conclusions: PD placement after total gastrectomy for GAC is associated with neither a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, nor a decrease in the need for secondary drainage procedures or reoperation. Routine use of PDs is not warranted.

AB - Background: The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established. Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified. The association of PD placement with postoperative outcomes was analyzed. Results: Overall, 344 patients were identified and 253 (74 %) patients received a PD. The anastomotic leak rate was 9 %. Those with PD placement had similar American Society of Anesthesiologists score, tumor size, TNM stage, and the need for additional organ resection when compared with their counterparts. No difference was observed in the rate of any complication (54 vs. 48 %; p = 0.45), major complication (25 vs. 24 %; p = 0.90), or 30-day mortality (7 vs. 4 %; p = 0.51) between the two groups. In addition, no difference in anastomotic leak (9 vs. 10 %; p = 0.90), the need for secondary drainage (10 vs. 9 %; p = 0.92), or reoperation (13 vs. 8 %; p = 0.28) was identified. On multivariate analysis, PD placement was not associated with decreased postoperative complications. Subset analysis, stratified by patients who did not undergo concomitant pancreatectomy (n = 319) or those who experienced anastomotic leak (n = 31), similarly demonstrated no association of PD placement with reduced complications or mortality. Conclusions: PD placement after total gastrectomy for GAC is associated with neither a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, nor a decrease in the need for secondary drainage procedures or reoperation. Routine use of PDs is not warranted.

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