Li HY, Liu Y, Cui WX, Zhao Q. Enhanced recovery after surgery in gastric cancer surgery: Systematic review and meta-analysis of perioperative indwelling drainage tube use. World J Gastrointest Surg 2025; 17(10): 108930 [PMID: 41178892 DOI: 10.4240/wjgs.v17.i10.108930]
Corresponding Author of This Article
Wen-Xiang Cui, School of Nursing, Yanbian University, No. 997 Park Road, Yanji 133002, Jilin Province, China. wxcui@ybu.edu.cn
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Gastroenterology & Hepatology
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Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Nov 17, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Li HY, Liu Y, Cui WX, Zhao Q. Enhanced recovery after surgery in gastric cancer surgery: Systematic review and meta-analysis of perioperative indwelling drainage tube use. World J Gastrointest Surg 2025; 17(10): 108930 [PMID: 41178892 DOI: 10.4240/wjgs.v17.i10.108930]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 108930 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.108930
Enhanced recovery after surgery in gastric cancer surgery: Systematic review and meta-analysis of perioperative indwelling drainage tube use
Hai-Yue Li, Yi Liu, Wen-Xiang Cui, Qian Zhao
Hai-Yue Li, Department of General Surgery, Yanbian University Hospital, Yanji 133002, Jilin Province, China
Yi Liu, Wen-Xiang Cui, Qian Zhao, School of Nursing, Yanbian University, Yanji 133002, Jilin Province, China
Co-first authors: Hai-Yue Li and Yi Liu.
Author contributions: Li HY and Liu Y conceived and designed the study, they contributed equally to this article, they are the co-first authors of this manuscript; Cui WX and Zhao Q conducted literature screening and data extraction; Li HY, Liu Y, and Zhao Q performed statistical analysis and drafted the manuscript; Cui WX critically revised the manuscript and supervised the overall project; and all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Xiang Cui, School of Nursing, Yanbian University, No. 997 Park Road, Yanji 133002, Jilin Province, China. wxcui@ybu.edu.cn
Received: April 30, 2025 Revised: June 30, 2025 Accepted: August 12, 2025 Published online: October 27, 2025 Processing time: 178 Days and 2.1 Hours
Abstract
BACKGROUND
The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial, particularly under the enhanced recovery after surgery (ERAS) protocol. ERAS advocates a multimodal perioperative strategy designed to attenuate surgical stress and optimize postoperative convalescence.
AIM
To evaluate the necessity of abdominal drainage tube placement following radical gastrectomy in the context of ERAS protocols.
METHODS
A systematic review and meta-analysis were conducted by searching PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP Information, and SinoMed databases for randomized controlled trials comparing outcomes of abdominal drainage vs no drainage after gastrectomy under ERAS protocols. Primary outcomes included time to gastrointestinal function recovery, drainage tube removal time, postoperative complication rates, and length of hospital stay. Review Manager 5.4 was used for statistical analysis, and heterogeneity was assessed using the I2 statistic.
RESULTS
A total of 21 randomized controlled trials involving 1652 patients were included. Compared with routine abdominal drainage, the ERAS group without drainage showed significantly faster gastrointestinal recovery [standardized mean difference = -1.30, 95% confidence interval (CI): -1.66 to -0.94, P < 0.00001] and shorter hospital stay (standardized mean difference = -1.37, 95%CI: -1.86 to -0.88, P < 0.00001). The incidence of total postoperative complications was also significantly lower (odds ratio = 0.53, 95%CI: 0.40-0.70, P < 0.00001), particularly for anastomotic leakage and pulmonary infection. No significant differences were observed in surgical site infections or urinary tract infections. Sensitivity and subgroup analyses indicated stability of results, although some heterogeneity was noted.
CONCLUSION
Avoiding routine abdominal drainage under ERAS could lead to faster recovery, reduced complications, and shorter hospital stay following radical gastrectomy, supporting the selective use of drainage rather than routine.
Core Tip: Enhanced recovery after surgery in radical gastrectomy supports early drain removal, faster gastrointestinal recovery, shorter hospitalization, and fewer complications. This review of 21 randomized controlled trials highlights safety and benefits, but also the need for better protocol standardization and region-specific adaptation, as current data stem solely from Asian populations. Strengthening protocol standardization, interdisciplinary coordination, and localized implementation strategies may enhance enhanced recovery after surgery effectiveness in clinical practice.
