Implementing a no-drain policy for extraperitoneal colorectal anastomosis in a real-life setting: analysis of outcomes and surgeons' adherence.

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2024-07-15 DOI:10.1007/s00384-024-04681-0

Jacopo Crippa, Antonio Luberto, Carmelo Magistro, Michele Carvello, Pietro Carnevali, Annalisa Maroli, Giovanni Carlo Ferrari, Antonino Spinelli

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Abstract

Aim: Recent evidence has questioned the usefulness of anastomotic drain (AD) after low anterior resection (LAR). However, the implementation and adoption of a no-drain policy are still poor. This study aims to assess the clinical outcomes of the implementation of a no-drain policy for rectal cancer surgery into a real-life setting and the adherence of the surgeons to such policy.

Method: A retrospective analysis was conducted on patients who underwent elective minimally invasive LAR between January 2015 and December 2019 at two tertiary referral centers. In 2017, both centers implemented a policy aimed at reducing the use of AD. Patients were retrospectively categorized into two groups: the drain policy (DP) group, comprising patients treated before 2017, and the no-drain policy (NDP) group, consisting of patients treated from 2017 onwards. The endpoints were the rate of anastomotic leak (AL) and of related interventions.

Results: Among the 272 patients included, 188 (69.1%) were in the NDP group, and 84 (30.9%) were in the DP group. Baseline characteristics were similar between the two groups. AL rate was 11.2% in the NDP group compared to 10.7% in the DP group (p = 1.000), and the AL grade distribution (grade A, 19.1% (4/21) vs 28.6% (2/9); grade B, 28.6% (6/21) vs 11.1% (1/9); grade C, 52.4% (11/21) vs 66.7% (6/9), p = 0.759) did not significantly differ between the groups. All patients with symptomatic AL and AD underwent surgical treatment for the leak, while those with symptomatic AL in the NPD group were managed with surgery (66.7%), endoscopic (19.0%), or percutaneous (14.3%) interventions. Postoperative outcomes were similar between the groups. Three years after implementing the no-drain policy, AD was utilized in only 16.5% of cases, compared to 76.2% at the study's outset.

Conclusion: The introduction of a no-drain policy received a good adoption rate and did not affect negatively the surgical outcomes.

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在真实环境中实施腹膜外结直肠吻合术免引流政策：对结果和外科医生遵守情况的分析。

目的：最近有证据质疑低位前路切除术（LAR）后吻合口引流管（AD）的作用。然而，无引流政策的实施和采用情况仍然不佳。本研究旨在评估在真实环境中实施直肠癌手术无引流政策的临床效果，以及外科医生对该政策的遵守情况：对2015年1月至2019年12月期间在两家三级转诊中心接受择期微创LAR手术的患者进行了回顾性分析。2017 年，两个中心都实施了旨在减少 AD 使用的政策。患者被回顾性地分为两组：引流政策（DP）组，包括2017年之前接受治疗的患者；无引流政策（NDP）组，包括2017年之后接受治疗的患者。终点是吻合口漏（AL）率和相关干预措施：在纳入的 272 例患者中，188 例（69.1%）属于 NDP 组，84 例（30.9%）属于 DP 组。两组患者的基线特征相似。NDP组的AL率为11.2%，而DP组为10.7%（P = 1.000），AL分级分布（A级，19.1%（4/21） vs 28.6%（2/9）；B级，28.6%（6/21） vs 11.1%（1/9）；C级，52.4%（11/21） vs 66.7%（6/9），P = 0.759）在两组间无显著差异。所有有症状的 AL 和 AD 患者都接受了手术治疗，而 NPD 组有症状的 AL 患者则接受了手术（66.7%）、内镜（19.0%）或经皮（14.3%）干预。两组患者的术后效果相似。在实施无引流政策三年后，仅有16.5%的病例使用了AD，而在研究开始时，这一比例为76.2%：结论：禁排政策的采用率很高，对手术效果没有负面影响。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.