Prophylactic Intra-Peritoneal Drainage After Pancreatic Resection: An Updated Meta-Analysis

Abstract

IntroductionProphylactic intra-peritoneal drainage has been considered to be an effective measure to reduce postoperative complications after pancreatectomy. However, routinely placed drainage during abdominal surgery may be unnecessary or even harmful to some patients, due to the possibility of increasing complications. And there is still controversy about the prophylactic intra-peritoneal drainage after pancreatectomy. This meta-analysis aimed to analyze the incidence of complications after either pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) in the drain group and no-drain group.MethodsData were retrieved from four electronic databases PubMed, EMBASE, the Cochrane Library and Web of Science up to December 2020, including the outcomes of individual treatment after PD and DP, mortality, morbidity, clinically relevant postoperative pancreatic fistula (CR-POPF), bile leak, wound infection, postoperative hemorrhage, delayed gastric emptying (DGE), intra-abdominal abscess, reoperation, intervened radiology (IR), and readmission. Cochrane Collaboration Handbook and the criteria of the Newcastle-Ottawa scale were used to assess the quality of studies included.ResultsWe included 15 studies after strict screening. 13 studies with 16,648 patients were analyzed to assess the effect of drain placement on patients with different surgery procedures, and 4 studies with 6,990 patients were analyzed to assess the effect of drain placement on patients with different fistula risk. For patients undergoing PD, the drain group had lower mortality but higher rate of CR-POPF than the no-drain group. For patients undergoing DP, the drain group had higher rates of CR-POPF, wound infection and readmission. There were no significant differences in bile leak, hemorrhage, DGE, intra-abdominal abscess, and IR in either overall or each subgroup. For Low-risk subgroup, the rates of hemorrhage, DGE and morbidity were higher after drainage. For High-risk subgroup, the rate of hemorrhage was higher while the rates of reoperation and morbidity were lower in the drain group.ConclusionsIntraperitoneal drainage may benefit some patients undergoing PD, especially those with high pancreatic fistula risk. For DP, current evidences suggest that routine drainage might not benefit patients, but no clear conclusions can be drawn because of the study limitations.

Prophylactic drainage versus non-drainage following gastric cancer surgery: a meta-analysis of randomized controlled trials and observational studies

“…However, in our present analysis based on 1049 patients, we found that PD did not show any advantage over ND in patients undergoing total gastrectomy. Unexpectedly, several recent meta-analyses demonstrated that even pancreaticoduodenectomy and major liver resection can safely avoid abdominal drainage, which indicated that PD is not a substitute for a meticulous surgical procedure in complex operations [8,45]. In view of this, avoiding routine drainage should also be recommended during total gastrectomy.…”

The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study

“…Drainage tube-related problems comprising 35.9% of patients in the discharged group ( n = 39) implied that this problem had relatively low acuity. The role of the routine intraoperative placement of drainage tubes during PD remains controversial [ 26 , 27 ]. Several meta-analysis studies have demonstrated comparable results between patients with or without routine drainage tube placement after PD, particularly for those at low risk of POPF [ 27 , 28 ].…”

“…The role of the routine intraoperative placement of drainage tubes during PD remains controversial [ 26 , 27 ]. Several meta-analysis studies have demonstrated comparable results between patients with or without routine drainage tube placement after PD, particularly for those at low risk of POPF [ 27 , 28 ]. Although it is not feasible to conclude the necessity of drainage tube placement, these results exhibited a notion of avoiding unnecessary drainage tube placement to avert postoperative complications [ 26 , 27 ].…”

“…Several meta-analysis studies have demonstrated comparable results between patients with or without routine drainage tube placement after PD, particularly for those at low risk of POPF [ 27 , 28 ]. Although it is not feasible to conclude the necessity of drainage tube placement, these results exhibited a notion of avoiding unnecessary drainage tube placement to avert postoperative complications [ 26 , 27 ]. Moreover, early removal of the drainage tube has been recognized as a part of enhanced recovery after surgery protocol for PD [ 29 ].…”

Safety evaluation of early drain removal following pancreaticoduodenectomy: A single-center retrospective cohort study

“…For example, Conlon et al (8) performed the first randomized controlled trial (RCT) to demonstrate that the placement of drainage after pancreatic resection failed to reduce postoperative complications, but increased the incidences of intra-abdominal collections and infection. Subsequently, multiple RCTs and metaanalysis proved the safety of omission of drainage after pancreatic resection (9)(10)(11)(12)(13). However, one RCT was stopped because of the significantly increased mortality from 3% to 12% for patients undergoing PD without the placement of intraperitoneal drainage (14).…”