Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-Institution Retrospective Study.

So-Jeong Yoon,In-Woong Han,Ji-Hye Jung,Sang-Hyun Shin,Dong-Wook Choi,Jin-Seok Heo,So-Kyung Yoon

doi:10.3390/jcm10122716

So-Jeong Yoon, In-Woong Han + Show 5 more

Open Access

https://doi.org/10.3390/jcm10122716

Copy DOI

Abstract

The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within 3 postoperative days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among the patients with drain fluid amylase < 5000 IU on the first postoperative day, the early removal group had fewer complications and shorter hospital stays than the late removal group (30.9% vs. 54.5%, p < 0.001; 9.8 vs. 12.5 days, p = 0.030, respectively). The incidences of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase CR-POPFs (p = 0.163). Although early drain removal has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

Highlights

Published: 19 June 2021Pancreatoduodenectomy (PD) is a major surgical procedure, mostly performed to remove periampullary tumors arising from the head of the pancreas, distal bile duct, duodenum, or ampulla of Vater
227 (50.4%) patients with other periampullary tumors arising from the distal common bile duct, duodenum, or ampulla of Vater
Soft pancreatic texture (OR = 2.261, 95% confidence intervals (CIs): 1.106–4.622, p = 0.025) and the tumor origin (OR = 0.212, 95% CI: 0.093–0.484, p < 0.001) were associated with the development of CR-postoperative pancreatic fistulas (POPFs)

Summary

Introduction

Published: 19 June 2021Pancreatoduodenectomy (PD) is a major surgical procedure, mostly performed to remove periampullary tumors arising from the head of the pancreas, distal bile duct, duodenum, or ampulla of Vater. The procedure is associated with perioperative mortality rates up to 2% [1], and overall complication rates of 40 to 50%, even at high-volume centers [2,3]. To reduce perioperative stress and optimize recovery after surgery, the Enhanced. The guidelines strongly recommend early drain removal at postoperative 72 h in patients with drain fluid amylase (DFA) levels of

Objectives

Methods

Results

Discussion

Conclusion