Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy

Kowalewski, Karl‐Friedrich; Hendrie, Jonathan D.; Nickel, Felix; Hardenberg, Jost von; Nuhn, Philipp; Honeck, Patrick; Michel, Maurice Stephan; Kriegmair, Maximilian C.

doi:10.1007/s00345-019-02978-2

Cited by 17 publications

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“…I appreciate the efforts—I went “cold turkey” over a year ago in dropping routine drains and have no concerns with this change in practice. For further reading, see the systematic review by Kowalewski et al 2 , which looks at drain use across all urologic cancers and shows similar results. To the Clinic… The study by Hurle et al 3 looks at a not too uncommon clinical problem—the high‐grade non‐invasive bladder cancer patient with BCG unresponsive outcome. The gold standard is early cystectomy; however, in this series of 36 patients who refused cystectomy, a salvage treatment with intravesical gemcitabine yielded at 24‐month 32% disease‐specific survival, and without high‐grade toxicity.…”

Section: Figurementioning

confidence: 92%

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confidence: 91%

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“…Считалось, что методом профилактики является установка страховых дренажей. Однако в недавнем систематическом обзоре и метаанализе было продемонстрировано, что нет корреляции отсутствия страховых дренажей с формированием симптоматических ЛК после ТЛАЭ [14][15][16].…”

Section: таблица 2 клинико-патологическая характеристика двух группunclassified

Comparison of clips and electrosurgical instruments in sealing of lymphatic vessels during pelvic lymph node dissection at the time of radical cystectomy

et al. 2021

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Background. Bladder cancer is very common and real problem in oncourology. The main treatment for muscle invasive bladder cancer is radical cystectomy (RC). RC with pelvic lymph node dissection (PLND) may be associated with an increased risk of developing lymphatic complications such as lymphedema, prolonged lymphorrhea, and the formation of lymphocele.Objective: to compare the efficiency of clips and surgical instruments for preventing the development of lymphatic complications during PLND at the time of RC.Materials and methods. From January 2016 to October 2020 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 were performed 60 RC with PLND. All patients were divided into two groups. The 1st group included patients who underwent the sealing of lymphatic vessels using titanium/polymer clips (n = 30). In the 2nd group the sealing was performed using ultrasonic/bipolar instruments (n = 30). All operations were performed by one surgeon. The study used univariate and multivariate logistic regression analysis.Results. The overall percentage of lymphatic complications was 29 (48.3 %) out of 60 patients. Out of them 7 (11.7 %) patients developed symptomatic lymphocele, and 3 (5.0 %) developed asymptomatic lymphocele, prolonged lymphorrhea was observed in 17 (28.3 %) patients, lymphedema of the lower extremities or genitals in 2 (3.3 %). The percentage of lymphatic complications in the 1st group was 66.7 % (n = 20), and in the 2nd group - 30.0 % (n = 9) (p = 0.004). In multivariate analysis the statistical significance was (p = 0.014), a high odds ratio (6.83; 95 % confidence interval 1.48-31.49) was observed with sealing of lymphatic vessels with clips, while a low odds ratio (0.14; 95 % confidence interval 0.03-0.67) was found with electrosurgical instruments.Conclusion. The use of ultrasonic or bipolar electrosurgical instruments can be an effective method for preventing the development of lymphatic complications during PLND at the time of RC.

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“…Findings concluded for prostatectomy and partial nephrectomy, the placement of a drain can be omitted unless there is a deviation from the standard care. However, for RC, the evidence was insufficient to suggest drain omission …”

Section: Intraoperative Componentsmentioning

confidence: 99%

Enhanced recovery after surgery review and urology applications in 2020

Pessôa¹,

Ürkmez

Kukreja

et al. 2020

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Purpose: To explore enhanced recovery after surgery (ERAS) components and their current application to major urologic surgeries, barriers to implementation and maintenance of the associated quality improvement. Data Identification: An English language literature search was done using PubMed. Study Selection: After independent review, 55 of the original 214 articles were selected to specifically address the stated purpose. Data Extraction: Clinical trials were included, randomized trials were prioritized, but robust observational studies were also included. Results of Data Synthesis: Many ERAS components have good data to support usage in radical cystectomy (RC) patients. Most ERAS programs include multidisciplinary teams carrying out multimodal pathways to hasten recovery after a major operation. ERAS components generally include preoperative counseling and medical optimization, venous thromboembolism prophylaxis, ileus prevention, avoidance of fluid overload, normothermia maintenance, early mobilization, pain control and early feeding, all leading to early discharge without increased complications or readmissions. Although there may not be specific data pertaining to other major urologic operations, the principles remain similar and ERAS is easily applicable. Conclusion: The benefits of ERAS programs are well established for RC and principles are easily applicable to other major urology operations. Barriers to implantation and maintenance of ERAS must be recognized to continue to maintain the benefits of these programs.

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Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy

Cited by 17 publications

References 48 publications

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Comparison of clips and electrosurgical instruments in sealing of lymphatic vessels during pelvic lymph node dissection at the time of radical cystectomy

Enhanced recovery after surgery review and urology applications in 2020

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