Efficacy And Safety Of Gastrectomy Abdominal Drains For Gastric Cancer: A Systematic Review

Objective:To assess the efficacy and safety of gastrectomy abdominal drainage after gastrectomy in gastric cancer surgery. Methods: Cochrane systematic evaluation was used to search through Cochrane library(2007-No.3) of clinical comparative trail, PubMed(1976-2008), Embase(1982-2008), Chinese Biomedical Literature Database (CBM1979-2008), Chinese Scientific Journal Full-text Database(CSJD1989-2008) and Chinese Journal Full-text Database(CJFD1994-2008), aided with manual retrieval and other retrievals. The quality of the assessment was independently evaluated and cross-checked by two evaluators .The results of homogeneous studies were analyzed with RevMan4.2.10 software. Results: A total of 47 articles were retrieved. Three randomized controlled trials involved. A total of 338 patients were studied. Of the 338 patients, 160 were treated with total gastrectomy, 178 subtotal gastrectomy and 167 were without gastrectomy drains. Above 3 trials never reported blind method and not described random allocation concealment method. No statistical differences were found in the pulmonary complication, wound infection, intra-abdominal abscess, clinical leakage and initiation of soft diet between gastrectomy drains and without drains odds ratio (OR)=1.23, 95% confidence interval (CI)=0.49-3.07 for pulmonary complication; OR=1.09 , 95%CI =0.36-3.29 for wound infection; OR=1.28, 95%CI =0.28-5.8 for intra-abdominal abscess; OR=1.53, 95%CI =0.25-9.42 for anastomotic leakage; OR=1.78, 95%CI =0.37-8.56 for hospital mortality; WMD=0.12, 95%CI=-0.11-0.35 for initiation of soft diet; WMD=0.65, 95%CI=0.03-1.26for gastrectomy statistical differences were found in hospital stay . Conclusions: The safety and efficacy of gastrectomy abdominal drainage in gastric cancer resection is not better than that of without drains . Time to initiation of soft diet, pulmonary complications, wound infection, intra-abdominal abscess, anastomotic leakage and mortality were similar in both groups. length of hospital stay in drains groups. Therefore , gastrectomy drains should not be recommended as a regular treatment for gastric surgery before obtaining evidences of its certain efficacy gastrectomy. There is a further demand for well-designed RCTs to clarify the value of prophylactic drainage. Abdominal drainage after gastrectomy should not be recommended as regular treatment for gastric cancer patients.