The role of abdominal drainage in pancreatic resection – A multicenter validation study for early drain removal
Background: Abdominal drainage and the timing of drain removal in patients undergoing pancreatic resection are under debate. Early drain removal after pancreatic resection has been reported to be safe with a low risk for clinical relevant postoperative pancreatic fistula (CR-POPF) when drain amylase on POD1 is < 5000U/L. The aim of this study was to validate this algorithm in a large national cohort. Methods: Patients registered in the Dutch Pancreatic Cancer Audit (2014–2016) who underwent pancreatoduodenectomy, distal pancreatectomy or enucleation were analysed. Data on post-operative drain amylase levels, drain removal, postoperative pancreatic fistulae were collected. Univariate and multivariate analysis using a logistic regression model were performed. The primary outcome measure was grade B/C pancreatic fistula (CR-POPF). Results: Among 1402 included patients, 433 patients with a drain fluid amylase level of <5000U/L on POD1, 7% developed a CR-POPF. For patients with an amylase level >5000U/L the CR-POPF rate was 28%. When using a cut-off point of 2000U/L or 1000U/L during POD1-3, the CR-POPF rates were 6% and 5% respectively. For patients with an amylase level of >2000U/L and >1000UL during POD 1–3 the CR-POPF rates were 26% and 22% respectively (n = 223). Drain removal on POD4 or thereafter was associated with more complications (p = 0.004). Drain amylase level was shown to be the most statistically significant predicting factor for CR-POPF (Wald = 49.7; p < 0.001). Conclusion: Our data support early drain removal after pancreatic resection. However, a cut-off of 5000U/L drain amylase on POD1 was associated with a relatively high CR-POPF rate of 7%. A cut-off point of 1000U/L during POD1-3 resulted in 5% CR-POPF and might be a safer alternative.
|Keywords||Drain, Fistula, Pancreas, PPPD, Whipple|
|Persistent URL||dx.doi.org/10.1016/j.pan.2019.07.041, hdl.handle.net/1765/119829|
Linnemann, R.J.A. (R. J.A.), Patijn, G.A, van Rijssen, L.B, Besselink, M.G, Mungroop, T.H. (T. H.), de Hingh, I.H.J.T, … Nieuwenhuijs, V.B. (2019). The role of abdominal drainage in pancreatic resection – A multicenter validation study for early drain removal. Pancreatology, 19(6), 888–896. doi:10.1016/j.pan.2019.07.041