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Purpose <p>The role of prophylactic pelvic drains in rectal surgery remains controversial. This study aimed to clarify the clinical impact of one major concern: retrograde drain infection.</p> Methods <p>The subjects of this retrospective study were 852 consecutive patients who underwent rectal cancer resection with bowel anastomosis and drain placement at a single referral hospital in Japan. Retrograde drain infections were categorized based on infection depth, as superficial/deep or organ/space. Patients with anastomotic leakage (<i>n</i> = 10) were excluded from the analysis. Outcomes included infection frequency, characteristics, risk factors, and oncological effects.</p> Results <p>Retrograde drain infection developed in 5.5% of the patients, with the vast majority (84.8%) diagnosed on or after postoperative day (POD) 7. Male sex was a significant risk factor (7.0% vs. 3.3%, <i>P</i> = 0.025). Patients with a retrograde drain infection had longer hospital stays (median 22 vs. 16 days, <i>P</i> &lt; 0.001). Organ/space infections were associated with poorer recurrence-free survival for patients with Stage I–III disease. Drain placement helped early detection in 6 of 10 patients with anastomotic leakage, avoiding stoma creation in 2 patients.</p> Conclusion <p>Retrograde drain infection occurs more frequently in male patients and prolongs the hospital stay. While prophylactic drains may aid early leakage detection, removal within 7 days is recommended to reduce infection risk.</p>

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Analysis of retrograde infection of prophylactic pelvic drains in rectal cancer surgery: a retrospective cohort study

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  • 发表日期：

    2026年3月19日

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  • Yuzo Nagai,
  • Hiroaki Nozawa,
  • Kazuhito Sasaki,
  • Koji Murono,
  • Shigenobu Emoto,
  • Kensuke Kaneko,
  • Yuichiro Yokoyama,
  • Shinya Abe,
  • Yuzo Harada,
  • Takahide Shinagawa,
  • Yuichi Tachikawa,
  • Soichiro Ishihara

摘要

Purpose

The role of prophylactic pelvic drains in rectal surgery remains controversial. This study aimed to clarify the clinical impact of one major concern: retrograde drain infection.

Methods

The subjects of this retrospective study were 852 consecutive patients who underwent rectal cancer resection with bowel anastomosis and drain placement at a single referral hospital in Japan. Retrograde drain infections were categorized based on infection depth, as superficial/deep or organ/space. Patients with anastomotic leakage (n = 10) were excluded from the analysis. Outcomes included infection frequency, characteristics, risk factors, and oncological effects.

Results

Retrograde drain infection developed in 5.5% of the patients, with the vast majority (84.8%) diagnosed on or after postoperative day (POD) 7. Male sex was a significant risk factor (7.0% vs. 3.3%, P = 0.025). Patients with a retrograde drain infection had longer hospital stays (median 22 vs. 16 days, P < 0.001). Organ/space infections were associated with poorer recurrence-free survival for patients with Stage I–III disease. Drain placement helped early detection in 6 of 10 patients with anastomotic leakage, avoiding stoma creation in 2 patients.

Conclusion

Retrograde drain infection occurs more frequently in male patients and prolongs the hospital stay. While prophylactic drains may aid early leakage detection, removal within 7 days is recommended to reduce infection risk.