Is Prophylactic Abdominal Drainage Necessary After Laparoscopic Colectomy For Colon Cancer? A Propensity Score-Matched Analysis

Abstract Background: In 2018, the Enhanced Recovery After Surgery (ERAS) Society recommended against routine drainage after colorectal surgery. However, the evidence is relatively old and few studies were performed in low-to-middle income country (LMIC) setting. This study aimed to compare outcomes of laparoscopic colectomy with and without prophylactic drainage for colon cancer.Methods: A retrospective study was performed from 2018 to 2021 with patients who underwent laparoscopic colectomy with D3 lymphadenectomy for colon cancer. The use of prophylactic drainage was depended on routine practice of surgeons. Outcomes were postoperative complications and postoperative hospital length of stay. The drain and no-drain groups were compared using propensity score-matched (PSM) analysis.Results: The study included 143 patients (59 in the drain group and 84 in the no-drain group). The PSM resulted in 94 patients (47 in each group). Median age was 62 years. The most frequent was right hemicolectomy (33.6%), followed by left hemicolectomy (32.2%), sigmoid colectomy (21%), extended right hemicolectomy (9.8%), transverse hemicolectomy (2.1%), and total colectomy (1.4%). Postoperative hospital stay was significantly shorter in the no-drain group (median of 5 versus 6 days). The no-drain group also had lower rate of complications (23.8% versus 30.5% and 23.4% versus 34% before and after matching respectively) and less severe complications based on Clavien-Dindo classification, but the difference was not significant.Conclusions: Laparoscopic colectomy without prophylactic drainage is safe in the treatment of colon cancer. This approach can shorten postoperative hospital stay and should be applied even in the LMIC setting.Main novel aspect: Laparoscopic colectomy without prophylactic drainage for colon cancer can be applied in low-to-middle income settings.