위암 환자에서 위 절제술 후 배액관 사용에 대한 무작위 전향적 연구

Abstract

Purpose: Drainage of the peritoneal cavity after abdominal surgery has been routinely practiced, although few data exist to scientifically support the efficacy of such an approach. In gastric cancer surgery, drainage is regarded as an essential procedure to keep the peritoneal cavity clear after extended lymphadenectomy and, also, to facilitate early detection of hemorrhage, and anastomotic or duodenal stump leakage. In this context, we planned a randomized prospective trial of drainage use after gastrectomy with extended lymphadenectomy.

Methods: Between February and July 2001, 170 patients who underwent gastrectomy with extended lymphadenectomy were randomly allocated to either a non-drainage (n=84) or drainage group (n=86). The primary outcome measure was the complication rate. Additional outcome measures were operation time, requirements of rescue analgesics, changes in the level of serum albumin and hemoglobin, and hospital stay.

Results: Demographic details, preoperative physical status, and pathologic features were not different between the two groups. Incidences of total gastrectomy and splenectomy among total gastrectomies were similar in both groups. However, operation time was shorter in the non-drainage group than in the drainage group (P=0.022). There were no differences in surgical outcome, including changes in hemoglobin and albumin levels, requirement for rescue analgesics, time to flatus or soft diet, and length of hospital stay. Complication rates were not different between the two groups (P=0.691), nor in the patterns of complication in either group. There was no operative mortality or reoperation.

Conclusion: Based on these results, routine abdominal drainage should not be mandatory or even standard after gastrectomy with extended lymphadenectomy for gastric cancer.