Summary of findings for the main comparison. Drain versus no drain for gastric cancer.
| Drain versus no drain for gastric cancer | ||||||
| Patient or population: gastric cancer Settings: hospital Intervention: drain versus no drain | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Drain versus no drain | |||||
| 30‐day mortality Death during the follow‐up Follow‐up: mean 30 days | 9 per 1000 | 16 per 1000 (3 to 71) | RR 1.73 (0.38 to 7.84) | 438 (4 studies) | ⊕⊝⊝⊝ very low1,2,3 | |
| Post‐operative complications | See comment | See comment | Not estimable | 0 (4 studies) | ⊕⊕⊝⊝ low3,4 | |
| Re‐operations Re‐operations during the follow‐up Follow‐up: mean 30 days | 26 per 1000 | 65 per 1000 (18 to 227) | RR 2.49 (0.71 to 8.74) | 230 (2 studies) | ⊕⊝⊝⊝ very low3,5,6 | |
| Operation time The time from the start to the end of operation. Scale from: 0 to 100. Follow‐up: mean 30 days7 | The mean operation time ranged across control groups from 132 to 159 minutes8 | The mean operation time in the intervention groups was 9.07 minutes higher (2.56 to 15.57 higher) | 378 (3 studies) | ⊕⊕⊝⊝ low3,9,10,11,12,13 | ||
| Length of post‐operative hospital stay The time from the day of operation to the day of discharge. Scale from: 0 to 100. Follow‐up: mean 30 days | The mean length of post‐operative hospital stay ranged across control groups from 8.39 to 12.9 days | The mean length of post‐operative hospital stay in the intervention groups was 0.69 days higher (0.18 to 1.21 higher) | 438 (4 studies) | ⊕⊕⊝⊝ low1,3,9 | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 The four included trials did not report the study design and implementation clearly, so most of the items of methodological quality were unclear. 2 30‐day mortality is a zero event for the Kim 2004 and Jiang 2008 trials and as a result less than half the total patients contribute to the meta‐analysis. 3 We only included four trials in this review, and all the four studies concluded that use of a drain had no additional benefits. Funnel plot was not drawn because of the limited numbers of studies. 4 Not all the included studies reported the complication data. And blinding was not clearly stated. 5 The two included trials did not report the study design and implementation clearly, so most of the items of methodological quality were unclear. 6 Only two included studies reported this result. 7 The follow‐up time of the three included trials was 30 days. 8 They were the lowest and the highest estimates of the scores in the no‐drain groups 9 The three included trials did not report the study design and implementation clearly, so most of the items of methodological quality were unclear. 10 Although the operation time was closely associated with the surgeon, the three trials reported that all the surgical procedures were by the same surgeon or the same group of surgeons. 11 All three trials compared drain with no drain directly. 12 The sample size of the three included studies was not very small and the operation was measured based on every included patient. 13 All the three studies were randomised controlled trials.