Utility of closed suction pelvic drains at time of large bowel resection for ovarian cancer

Eleftheria Kalogera, Sean C. Dowdy, Andrea Mariani, Giovanni Aletti, Jamie N. Bakkum-Gamez, William A. Cliby

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To test the hypothesis that the use of closed suction pelvic drains placed at time of large bowel resection (LBR) for ovarian cancer (OC) decreases morbidity following anastomotic leak (AL). Methods: Consecutive cases of LBR for OC between 01/01/1994 and 06/20/2011 were retrospectively identified. Drains were routinely used until bowel movement. AL was defined as: 1) feculent fluid from drains/wound/vagina, 2) radiographic evidence of AL, or 3) AL found at reoperation. Descriptive statistics, Wilcoxon rank-sum, Pearson's chi-square and Fisher's exact test were used. Results: 43 cases met inclusion criteria. AL was characterized by method of diagnosis as follows: change in drain output only (DO, n = 8); change in drain output associated with ambiguous clinical signs/symptoms (D-SSX, n = 11); or clinical signs/symptoms only (SSX, n = 24). The sensitivity of drains in diagnosing AL was 50%. Time to diagnosis was earlier in DO/D-SSX (median 7 vs. 11 days, P = 0.003), however, no significant differences were observed in rates of reoperation, length of stay, time to chemotherapy (TTC), and 30- and 90-day mortality between DO/D-SSX and SSX. Comparing cases where no drains were placed (n = 5) vs. those with drain (n = 38), we observed no differences in outcomes. TTC though statistically significant (47 vs. 59 days, P = 0.023) was not clinically significant. Conclusions: Though a change in drain output correlated with earlier diagnosis, this did not appear to impact overall outcomes. We did not find strong evidence supporting routine prolonged drainage after LBR for OC. Additionally, absence of change in drain output does not rule out presence of AL.

Original languageEnglish
Pages (from-to)391-396
Number of pages6
JournalGynecologic Oncology
Volume126
Issue number3
DOIs
Publication statusPublished - Sep 2012

Fingerprint

Anastomotic Leak
Suction
Ovarian Neoplasms
Reoperation
Signs and Symptoms
Drug Therapy
Vagina
Early Diagnosis
Drainage
Length of Stay
Morbidity
Mortality
Wounds and Injuries

Keywords

  • Anastomotic leak
  • Large bowel resection
  • Ovarian cancer
  • Pelvic drain

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

Utility of closed suction pelvic drains at time of large bowel resection for ovarian cancer. / Kalogera, Eleftheria; Dowdy, Sean C.; Mariani, Andrea; Aletti, Giovanni; Bakkum-Gamez, Jamie N.; Cliby, William A.

In: Gynecologic Oncology, Vol. 126, No. 3, 09.2012, p. 391-396.

Research output: Contribution to journalArticle

Kalogera, Eleftheria ; Dowdy, Sean C. ; Mariani, Andrea ; Aletti, Giovanni ; Bakkum-Gamez, Jamie N. ; Cliby, William A. / Utility of closed suction pelvic drains at time of large bowel resection for ovarian cancer. In: Gynecologic Oncology. 2012 ; Vol. 126, No. 3. pp. 391-396.
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AB - Objective: To test the hypothesis that the use of closed suction pelvic drains placed at time of large bowel resection (LBR) for ovarian cancer (OC) decreases morbidity following anastomotic leak (AL). Methods: Consecutive cases of LBR for OC between 01/01/1994 and 06/20/2011 were retrospectively identified. Drains were routinely used until bowel movement. AL was defined as: 1) feculent fluid from drains/wound/vagina, 2) radiographic evidence of AL, or 3) AL found at reoperation. Descriptive statistics, Wilcoxon rank-sum, Pearson's chi-square and Fisher's exact test were used. Results: 43 cases met inclusion criteria. AL was characterized by method of diagnosis as follows: change in drain output only (DO, n = 8); change in drain output associated with ambiguous clinical signs/symptoms (D-SSX, n = 11); or clinical signs/symptoms only (SSX, n = 24). The sensitivity of drains in diagnosing AL was 50%. Time to diagnosis was earlier in DO/D-SSX (median 7 vs. 11 days, P = 0.003), however, no significant differences were observed in rates of reoperation, length of stay, time to chemotherapy (TTC), and 30- and 90-day mortality between DO/D-SSX and SSX. Comparing cases where no drains were placed (n = 5) vs. those with drain (n = 38), we observed no differences in outcomes. TTC though statistically significant (47 vs. 59 days, P = 0.023) was not clinically significant. Conclusions: Though a change in drain output correlated with earlier diagnosis, this did not appear to impact overall outcomes. We did not find strong evidence supporting routine prolonged drainage after LBR for OC. Additionally, absence of change in drain output does not rule out presence of AL.

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