Abstract
BackgroundAlthough drainage of pancreatic anastomoses after pancreaticoduodenectomy (PD) is still debated, it remains recommended, especially in patients with a high risk of post-operative pancreatic fistula (POPF). Modalities of drainage of pancreatic anastomoses, especially the use of passive (PAD) or closed-suction (CSD) drains, and their impact on surgical outcomes, have been poorly studied. The aim was to compare CSD versus PAD on surgical outcomes after PD.MethodsRetrospective analysis of 197 consecutive patients who underwent a standardized PD at two tertiary centers between March 2012 and April 2015. Patients with PAD (n = 132) or CSD (n = 65) were compared.ResultsThere was no significant difference in terms of 30-day overall and severe post-operative morbidity, post-operative hemorrhage, post-operative intra-abdominal fluid collections, 90-day post-operative mortality and mean length of hospital stay. The rate of POPF was significantly increased in the CSD group (47.7% vs. 32.6%; p = 0.04). CSD was associated with an increase of grade A POPF (21.5% vs. 8.3%; p = 0.03), while clinically relevant POPF were not impacted. In patients with grade A POPF, the rate of undrained intra-abdominal fluid collections was increased in the PAD group (46.1% vs. 21.4%; p = 0.18). After multivariate analysis, CSD was an independent factor associated with an increased rate of POPF (OR = 2.43; p = 0.012).ConclusionsThere was no strongly relevant difference in terms of surgical outcomes between PAD or CSD of pancreatic anastomoses after PD, but CSD may help to decrease the rate of undrained post-operative intra-abdominal collections in some patients. Further randomized, multi-institutional studies are needed.
Highlights
Drainage of pancreatic anastomoses after pancreaticoduodenectomy (PD) is still debated, it remains recommended, especially in patients with a high risk of post-operative pancreatic fistula (POPF)
Prophylactic drainage in hepatic and colorectal surgery has shown no clear benefit on post-operative morbidity [25,26,27,28], the problematic is highly different in pancreatic surgery due to the high risk of non-diagnosed and undrained POPF, with high risk of post-operative hemorrhage and death
There was no significant difference between the two groups in terms of 30-day overall (71.2% vs. 70.8% (n = 46); p = 0.93) and severe (37.9% vs. 40%; p = 0.93) post-operative morbidity, post-operative hemorrhage (9.0% vs. 9.2%; p = 0.97), 90-day postoperative mortality (15.2% vs. 12.3%; p = 0.59) and mean length of hospital stay (28 ± 18 days vs. 31 ± 48 days; p = 0.17) (Table 2)
Summary
Drainage of pancreatic anastomoses after pancreaticoduodenectomy (PD) is still debated, it remains recommended, especially in patients with a high risk of post-operative pancreatic fistula (POPF). Modalities of drainage of pancreatic anastomoses, especially the use of passive (PAD) or closed-suction (CSD) drains, and their impact on surgical outcomes, have been poorly studied. Post-operative pancreatic fistula (POPF) is the most frequent and feared complication after PD, reported in 5 to 48% of patients [2,3,4,5, 7, 9, 10, 12, 13] and is responsible for a high post-operative mortality that could reach 12% after PD [2,3,4,5, 7, 9]. Modalities of drainage of pancreatic anastomoses, especially the use of passive (PAD) or closed-suction (CSD) drains, strongly vary among surgical teams, and their impact on surgical outcomes has been poorly studied. The aim of our study was to compare the use of CSD versus PAD on surgical outcomes after PD at two tertiary centers
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