Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis

Davide Cavaliere, Georgi Popivanov, Diletta Cassini, Roberto Cirocchi, Brandon M Henry, Nereo Vettoretto, Giorgio Ercolani, Leonardo Solaini, Chiara Gerardi, Mihail Tabakov, Krzysztof Andrzej Tomaszewski

Research output: Contribution to journalReview article

Abstract

OBJECTIVE: The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prophylactic drains in anterior rectal resections.

METHODS: A systematic search was conducted of MEDLINE, Scopus, EMBASE, and Cochrane Library databases to identify clinical trials comparing the use of drainage to non-drainage in cases of colorectal anastomosis.

RESULTS: Three randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) were identified that met the inclusion criteria, with a total of 1702 patients with rectal cancer who underwent anterior resection: 1206 with a pelvic drain and 496 without a pelvic drain. Meta-analysis showed that the use of a drain did not significantly improve the outcomes of anastomotic leaks; the overall reoperation rate during the 30-day postoperative period and the postoperative mortality were statistically lower in the drained group (OR 2.82, 95% CI 1.33 to 5.97; I2 = 0%).

CONCLUSIONS: The use of prophylactic pelvic drainage after anterior rectal resections does not provide significant benefits with respect to anastomotic leaks and overall complication rates. However, an approximately threefold reduction of the postoperative mortality of the drained patients was observed. Given the limitations of the present study, these findings warrant the use of a drain after anterior rectal resection. Nevertheless, due to the low quality of the available data, further multicenter trials with uniform inclusion criteria are needed to evaluate drain usage in the anterior rectal resection.

Original languageEnglish
Pages (from-to)973-981
Number of pages9
JournalInternational Journal of Colorectal Disease
Volume34
Issue number6
DOIs
Publication statusPublished - Jun 2019

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Anastomotic Leak
Rectum
Meta-Analysis
Drainage
Colorectal Surgery
Mortality
Controlled Clinical Trials
Rectal Neoplasms
Reoperation
Postoperative Period
MEDLINE
Libraries
Multicenter Studies
Randomized Controlled Trials
Clinical Trials
Databases

Cite this

Cavaliere, D., Popivanov, G., Cassini, D., Cirocchi, R., Henry, B. M., Vettoretto, N., ... Tomaszewski, K. A. (2019). Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. International Journal of Colorectal Disease, 34(6), 973-981. https://doi.org/10.1007/s00384-019-03276-4

Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. / Cavaliere, Davide; Popivanov, Georgi; Cassini, Diletta; Cirocchi, Roberto; Henry, Brandon M; Vettoretto, Nereo; Ercolani, Giorgio; Solaini, Leonardo; Gerardi, Chiara; Tabakov, Mihail; Tomaszewski, Krzysztof Andrzej.

In: International Journal of Colorectal Disease, Vol. 34, No. 6, 06.2019, p. 973-981.

Research output: Contribution to journalReview article

Cavaliere, D, Popivanov, G, Cassini, D, Cirocchi, R, Henry, BM, Vettoretto, N, Ercolani, G, Solaini, L, Gerardi, C, Tabakov, M & Tomaszewski, KA 2019, 'Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis', International Journal of Colorectal Disease, vol. 34, no. 6, pp. 973-981. https://doi.org/10.1007/s00384-019-03276-4
Cavaliere, Davide ; Popivanov, Georgi ; Cassini, Diletta ; Cirocchi, Roberto ; Henry, Brandon M ; Vettoretto, Nereo ; Ercolani, Giorgio ; Solaini, Leonardo ; Gerardi, Chiara ; Tabakov, Mihail ; Tomaszewski, Krzysztof Andrzej. / Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. In: International Journal of Colorectal Disease. 2019 ; Vol. 34, No. 6. pp. 973-981.
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title = "Is a drain necessary after anterior resection of the rectum?: A systematic review and meta-analysis",
abstract = "OBJECTIVE: The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prophylactic drains in anterior rectal resections.METHODS: A systematic search was conducted of MEDLINE, Scopus, EMBASE, and Cochrane Library databases to identify clinical trials comparing the use of drainage to non-drainage in cases of colorectal anastomosis.RESULTS: Three randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) were identified that met the inclusion criteria, with a total of 1702 patients with rectal cancer who underwent anterior resection: 1206 with a pelvic drain and 496 without a pelvic drain. Meta-analysis showed that the use of a drain did not significantly improve the outcomes of anastomotic leaks; the overall reoperation rate during the 30-day postoperative period and the postoperative mortality were statistically lower in the drained group (OR 2.82, 95{\%} CI 1.33 to 5.97; I2 = 0{\%}).CONCLUSIONS: The use of prophylactic pelvic drainage after anterior rectal resections does not provide significant benefits with respect to anastomotic leaks and overall complication rates. However, an approximately threefold reduction of the postoperative mortality of the drained patients was observed. Given the limitations of the present study, these findings warrant the use of a drain after anterior rectal resection. Nevertheless, due to the low quality of the available data, further multicenter trials with uniform inclusion criteria are needed to evaluate drain usage in the anterior rectal resection.",
author = "Davide Cavaliere and Georgi Popivanov and Diletta Cassini and Roberto Cirocchi and Henry, {Brandon M} and Nereo Vettoretto and Giorgio Ercolani and Leonardo Solaini and Chiara Gerardi and Mihail Tabakov and Tomaszewski, {Krzysztof Andrzej}",
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T1 - Is a drain necessary after anterior resection of the rectum?

T2 - A systematic review and meta-analysis

AU - Cavaliere, Davide

AU - Popivanov, Georgi

AU - Cassini, Diletta

AU - Cirocchi, Roberto

AU - Henry, Brandon M

AU - Vettoretto, Nereo

AU - Ercolani, Giorgio

AU - Solaini, Leonardo

AU - Gerardi, Chiara

AU - Tabakov, Mihail

AU - Tomaszewski, Krzysztof Andrzej

PY - 2019/6

Y1 - 2019/6

N2 - OBJECTIVE: The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prophylactic drains in anterior rectal resections.METHODS: A systematic search was conducted of MEDLINE, Scopus, EMBASE, and Cochrane Library databases to identify clinical trials comparing the use of drainage to non-drainage in cases of colorectal anastomosis.RESULTS: Three randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) were identified that met the inclusion criteria, with a total of 1702 patients with rectal cancer who underwent anterior resection: 1206 with a pelvic drain and 496 without a pelvic drain. Meta-analysis showed that the use of a drain did not significantly improve the outcomes of anastomotic leaks; the overall reoperation rate during the 30-day postoperative period and the postoperative mortality were statistically lower in the drained group (OR 2.82, 95% CI 1.33 to 5.97; I2 = 0%).CONCLUSIONS: The use of prophylactic pelvic drainage after anterior rectal resections does not provide significant benefits with respect to anastomotic leaks and overall complication rates. However, an approximately threefold reduction of the postoperative mortality of the drained patients was observed. Given the limitations of the present study, these findings warrant the use of a drain after anterior rectal resection. Nevertheless, due to the low quality of the available data, further multicenter trials with uniform inclusion criteria are needed to evaluate drain usage in the anterior rectal resection.

AB - OBJECTIVE: The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prophylactic drains in anterior rectal resections.METHODS: A systematic search was conducted of MEDLINE, Scopus, EMBASE, and Cochrane Library databases to identify clinical trials comparing the use of drainage to non-drainage in cases of colorectal anastomosis.RESULTS: Three randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) were identified that met the inclusion criteria, with a total of 1702 patients with rectal cancer who underwent anterior resection: 1206 with a pelvic drain and 496 without a pelvic drain. Meta-analysis showed that the use of a drain did not significantly improve the outcomes of anastomotic leaks; the overall reoperation rate during the 30-day postoperative period and the postoperative mortality were statistically lower in the drained group (OR 2.82, 95% CI 1.33 to 5.97; I2 = 0%).CONCLUSIONS: The use of prophylactic pelvic drainage after anterior rectal resections does not provide significant benefits with respect to anastomotic leaks and overall complication rates. However, an approximately threefold reduction of the postoperative mortality of the drained patients was observed. Given the limitations of the present study, these findings warrant the use of a drain after anterior rectal resection. Nevertheless, due to the low quality of the available data, further multicenter trials with uniform inclusion criteria are needed to evaluate drain usage in the anterior rectal resection.

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DO - 10.1007/s00384-019-03276-4

M3 - Review article

C2 - 31025093

VL - 34

SP - 973

EP - 981

JO - International Journal of Colorectal Disease

JF - International Journal of Colorectal Disease

SN - 0179-1958

IS - 6

ER -