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01-05-2016 | Original Scientific Report

Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

Authors: Suguru Yamashita, Takeaki Ishizawa, Akihiko Ichida, Junichi Kaneko, Taku Aoki, Yoshihiro Sakamoto, Yasuhiko Sugawara, Kiyoshi Hasegawa, Norihiro Kokudo

Published in: World Journal of Surgery | Issue 5/2016

Abstract

Background

A method to completely prevent postoperative pancreatic fistula (PF) in distal pancreatectomy (DP) is lacking. Hence, prophylactic abdominal drains could be used to prevent PF from developing into life-threatening complications.

Methods

In 152 consecutive patients undergoing DP, three drains were placed routinely toward the pancreatic stump, supra-pancreatic space, and left subphrenic space. Abdominal drains were removed after surgery gradually based on amylase levels and positivity for bacterial infection in abdominal fluids.

Results

Postoperative symptomatic PF occurred in 57 of 152 patients (37.5 %). Prevalence of severe postoperative complications (Clavien–Dindo grade ≥IIIa) was 16 %, with surgery-associated mortality observed in one patient (0.7 %). Prevalence of infection in drained abdominal fluids increased gradually and was >10 % on postoperative day (POD)-7. Severe postoperative complications led to longer postoperative hospital stays and higher treatment costs. Multivariate analyses revealed that a body mass index ≥25 kg/m², serum albumin level ≤3.8 g/dL, and white blood cell count at POD-3 ≥15,000/μL were independent predictors for development of severe postoperative complications.

Conclusion

Use of prophylactic abdominal drains in DP seems to be effective for preventing PF from developing into fatal complications. However, definitive criteria should be established for enhancing safety and cost efficiency of DP through selective use and early removal of prophylactic drains.

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Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257CrossRefPubMedPubMedCentral

Mckay A, Mackenzie S, Sutherland FR et al (2006) Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. Br J Surg 93:929–936CrossRefPubMed

Fuks D, Piessen G, Huet E et al (2009) Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg 197:702–709CrossRefPubMed

Baumel H, Huguier M, Manderscheid JC et al (1994) Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery. Br J Surg 81:102–107CrossRefPubMed

Fabre JM, Houry S, Manderscheid JC et al (1996) Surgery for left-sided pancreatic cancer. Br J Surg 83:1065–1070CrossRefPubMed

Fahy BN, Frey CF, Ho HS et al (2002) Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 183:237–241CrossRefPubMed

Büchler MW, Wagner M, Schmied BM et al (2003) Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 138:1310–1315CrossRefPubMed

Kleeff J, Diener MK, Z’graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582CrossRefPubMedPubMedCentral

Pannegeon V, Pessaux P, Sauvanet A et al (2006) Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 141:1071–1076CrossRefPubMed

10.

Paye F, Micelli Lupinacci R et al (2015) Distal pancreatectomy for pancreatic carcinoma in the era of multimodal treatment. Br J Surg 102:229–236CrossRefPubMed

11.

Van Buren G 2nd, Bloomston M, Hughes SJ et al (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259:605–612CrossRefPubMed

12.

Sugiyama M, Suzuki Y, Abe N et al (2010) Secure placement of a peripancreatic drain after a distal pancreatectomy. Am J Surg 199:178–182CrossRefPubMed

13.

Yoshikawa K, Konishi M, Takahashi S et al (2011) Surgical management for the reduction of postoperative hospital stay following distal pancreatectomy. Hepatogastroenterology 58:1389–1393CrossRefPubMed

14.

Conlon KC, Labow D, Leung D et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–494CrossRefPubMedPubMedCentral

15.

Adham M, Chopin-Laly X, Lepilliez V et al (2013) Pancreatic resection: drain or no drain? Surgery 154:1069–1077CrossRefPubMed

16.

Correa-Gallego C, Brennan MF, Dʼangelica M et al (2013) Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution. Ann Surg 258:1051–1058CrossRefPubMed

17.

Fisher WE, Hodges SE, Silberfein EJ et al (2011) Pancreatic resection without routine intraperitoneal drainage. HPB (Oxf) 13:503–510CrossRef

18.

Diener MK, Tadjalli-Mehr K, Wente MN et al (2011) Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Langenbecks Arch Surg 396:41–52CrossRefPubMed

19.

Zhou Y, Zhang X, Wu L et al (2014) Evidence-based value of prophylactic intraperitoneal drainage following pancreatic resection: a meta-analysis. Pancreatology 14:302–307CrossRefPubMed

20.

Japan Pancreas Society (2011) Classification of pancreatic carcinoma, 3rd edn. Kanehara, Tokyo

21.

Konishi T, Hiraishi M, Kubota K et al (1995) Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy. Ann Surg 221:165–170CrossRefPubMedPubMedCentral

22.

Diener MK, Seiler CM, Rossion I et al (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377:1514–1522CrossRefPubMed

23.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed

24.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

25.

Kawai M, Kondo S, Yamaue H et al (2011) Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 18:601–608CrossRefPubMed

26.

Yoshioka R, Saiura A, Koga R et al (2010) Risk factors for clinical pancreatic fistula after pancreatectomy: analysis of consecutive 100 patients. World J Surg 34:121–125. doi:10.1007/s00268-009-0300-3 CrossRefPubMed

27.

Pratt WB, Callery MP, Vollmer CM Jr (2008) Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 32:419–428. doi:10.1007/s00268-007-9388-5 CrossRefPubMed

28.

Dong X, Zhang B, Kang MX et al (2011) Analysis of pancreatic fistula according to the International Study Group on Pancreatic Fistula classification scheme for 294 patients who underwent pancreaticoduodenectomy in a single center. Pancreas 40:222–228CrossRefPubMed

29.

Sierzega M, Niekowal B, Kulig J et al (2007) Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg 205:52–59CrossRefPubMed

30.

Sledzianowski JF, Duffas JP, Muscari F et al (2005) Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery 137:180–185CrossRefPubMed

31.

Yeh TS, Jan YY, Jeng LB et al (1997) Pancreaticojejunal anastomotic leak after pancreaticoduodenectomyemultivariate analysis of perioperative risk factors. J Surg Res 67:119–125CrossRefPubMed

32.

Akamatsu N, Sugawara Y, Komagome M et al (2010) Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. J Hepatobiliary Pancreat Sci 17:322–328CrossRefPubMed

33.

Bu X, Xu J, Dai X (2010) A novel technique for the management of pancreaticojejunal anastomosis dehiscence following pancreaticoduodenectomy. Dig Surg 27:265–271CrossRefPubMed

34.

Bu X, Xu Y, Xu J et al (2013) Continuous irrigation around pancreatic remnant decreases pancreatic fistula-related intraabdominal complications after distal pancreatectomy. Langenbecks Arch Surg 398:1083–1089CrossRefPubMed

35.

Strasberg SM, Linehan DC, Hawkins WG (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204:244–249CrossRefPubMed

36.

Hirano S, Kondo S, Hara T et al (2007) Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg 246:46–51CrossRefPubMedPubMedCentral

37.

Kondo S, Katoh H, Hirano S et al (2003) Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbecks Arch Surg 388:101–106CrossRefPubMed

38.

Kawai M, Tani M, Terasawa H et al (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244:1–7CrossRefPubMedPubMedCentral

39.

Molinari E, Bassi C, Salvia R et al (2007) Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg 246:281–287CrossRefPubMedPubMedCentral

40.

Gebauer F, Kloth K, Tachezy M et al (2012) Options and limitations in applying the fistula classification by the International Study Group for Pancreatic Fistula. Ann Surg 256:130–138CrossRefPubMed

41.

Shinchi H, Wada K, Traverso LW (2006) The usefulness of drain data to identify a clinically relevant pancreatic anastomotic leak after pancreaticoduodenectomy? J Gastrointest Surg 10:490–498CrossRefPubMed

42.

Wormsley KG, Goldberg DM (1972) The interrelationships of the pancreatic enzymes. Gut 13:398–412CrossRefPubMedPubMedCentral

43.

Keller J, Layer P (2002) Circadian pancreatic enzyme pattern and relationship between secretory and motor activity in fasting humans. J Appl Physiol 93:592–600CrossRefPubMed

44.

Dagorn JC, Sahel J, Sarles H (1977) Nonparallel secretion of enzymes in human duodenal juice and pure pancreatic juice collected by endoscopic retrograde catheterization of the papilla. Gastroenterology 73:42–45PubMed

45.

Reseland JE, Holm H, Jenssen T et al (1995) Inhibitor-stimulated non-parallel pancreatic secretion in man: hormonal and neural regulation? Scand J Gastroenterol 30:72–80CrossRefPubMed

46.

Yamashita S, Sakabe M, Ishizawa T et al (2013) Visualization of the leakage of pancreatic juice using a chymotrypsin-activated fluorescent probe. Br J Surg 100:1220–1228CrossRefPubMed

47.

Nagai S, Fujii T, Kodera Y et al (2011) Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol 18:2329–2337CrossRefPubMed

48.

Bellone G, Novarino A, Vizio B et al (2009) Impact of surgery and chemotherapy on cellular immunity in pancreatic carcinoma patients in view of an integration of standard cancer treatment with immunotherapy. Int J Oncol 34:1701–1715CrossRefPubMed

Title: Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy
Authors: Suguru Yamashita
Takeaki Ishizawa
Akihiko Ichida
Junichi Kaneko
Taku Aoki
Yoshihiro Sakamoto
Yasuhiko Sugawara
Kiyoshi Hasegawa
Norihiro Kokudo
Publication date: 01-05-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 5/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3399-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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