Is totally laparoscopic gastrectomy without prophylactic drains feasible for patients with distal gastric cancer? The experience of China National Cancer Center

Abstract Background Prophylactic drains have been used to remove intraperitoneal collections and to detect complications early in open surgery. In the last decades, Gastric cancer minimally invasive surgery has been widely carried out throughout the world. However, little has been reported on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy. To evaluate the feasibility of without prophylactic drains in totally laparoscopic distal gastrectomy in selective patients. Methods Data of distal gastric cancer patients underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed. The outcomes of patients with and without a prophylactic drainage were compared. Results A total of 420 patients who underwent surgery for gastric cancer were identified; of these, 88 patients who received totally lapaoscopic distal gastrectomy were included. The incidence of concurrent illness was higher in the drain group, (48.8% vs. 27.7%, p = 0.041). The overall postoperative complication rate was 19.5% in the drain group (n = 47), and 10.6% in the no-drain group (n = 41), there were no significant differences between two groups (p > 0.05). The need for percutaneous catheter drainage (PCD) was also not significantly different between groups (9.8% vs. 6.4%, p = 0.700). However, patients with larger BMI (≥ 29) are prone to postoperative complications (p = 0.042). In addition, more operating time cost in the drain group than in the no-drain group (188.10 ± 38.89 min vs. 164.30 ± 36.97 min, p < 0.05). The number of days after surgery until the initiation of soft diet (5.34 ± 2.27 days vs. 4.17 ± 2.13 days, p < 0.05) and first flatus (4.29 ± 1.45 days vs. 3.55 ± 1.83 days, p = 0.041) were greater in the drain group. Conclusions Without prophylactic drainage may reduce surgery time and result in faster recovery. Routine prophylactic drains are not necessary in selective patients. A prophylactic drain may be useful in patients at higher risk.