Drainage After Rectal Excision for Rectal Cancer (GRECCAR 5)

University Hospital of Bordeaux

Status and phase: Completed; Phase 3

Conditions: Randomized Clinical Trial; Multicenter Study; Rectal Cancer Surgery; Pelvic Drainage

Treatments: Procedure: Laying and management of the drain (strictly randomized arm with drainage); Procedure: No pelvic drainage

Study type: Interventional

Funder types: Other

Identifiers

NCT01269567

CHUBX 2010/24

Details and patient eligibility

About

After rectal excision, the rate of anastomotic leak and abscess is higher than after colic surgery. In order to limit and avoid the risk of pelvic sepsis after rectal excision, a prophylactic pelvic drainage is usually used. If current data have confirmed the uselessness of drainage in colic surgery, the question stay in abeyance in rectal surgery. This practice had never been evaluated in patients with rectal excision and low anastomosis (patients with a high risk of pelvic sepsis)

Full description

After rectal excision, the rate of anastomotic leak and abscess is higher than after colic surgery. In order to limit and avoid the risk of pelvic sepsis after rectal excision, a prophylactic pelvic drainage is usually used. If current data have confirmed the uselessness of drainage in colic surgery, the question stay in abeyance in rectal surgery. This practice had never been evaluated in patients with rectal excision and low anastomosis (patients with a high risk of pelvic sepsis) The aim of the study is to assess the impact of pelvic drainage vs. non pelvic drainage on risk of pelvic sepsis after rectal excision for cancer with infraperitoneal anastomosis. The principal objective is to compare the rate of pelvic sepsis until 30 days between the 2 groups of patients who had a rectal excision with and without pelvic drainage. It is a randomized clinical trial of superiority, multicentric, without blinding, in 2 parallel groups with ratio (1:1): distribution of the number of patients in the groups.

Enrollment: 494 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Rectal adenocarcinoma, histopathologically proved, with or without neoadjuvant treatment
• Stapler or manual infraperitoneal anastomosis
• With or without stoma
• With bowel preparation
• Open or laparoscopic approach
• Stage T1-T4 Nx Mx
• Age 18 years old or older
• Information of the patient and signature of informed consent
• Affiliation to a regime of social insurance

Exclusion criteria

• Colonic cancer (> 15 cm from anal verge)
• Abdominoperineal resection
• Associated resection (prostate, seminal bladder, vagina...)
• Simultaneous liver resection
• Total coloproctectomy
• Emergency
• Infected rectal tumour
• Pregnant women, suitable to be, or current suckling
• Persons deprived of freedom or under guardianship
• Persons under protection of justice
• Impossibility to accept the medical follow-up of the study for geographic , social or psychic reasons.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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494 participants in 2 patient groups

Drainage

Active Comparator group

Description:

Rectal excision with aspiration pelvic drainage

Treatment:

Procedure: Laying and management of the drain (strictly randomized arm with drainage)

No drainage

Experimental group

Description:

Rectal excision without aspiration pelvic drainage

Treatment:

Procedure: No pelvic drainage