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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 8/2020

01-12-2020 | Pancreatoduodenostomy | Systematic Reviews and Meta-analyses

Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

Authors: Sergio Pedrazzoli, Alessandra R. Brazzale

Published in: Langenbeck's Archives of Surgery | Issue 8/2020

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Abstract

Purpose

Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF).

Methods

PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies.

Results

Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis.

Conclusion

Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.
Appendix
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Literature
1.
van Rijssen LB, Zwart MJ, van Dieren S, de Rooij T, Bonsing BA, Bosscha K, van Dam RM, van Eijck CH, Gerhards MF, Gerritsen JJ, van der Harst E, de Hingh IH, de Jong KP, Kazemier G, Klaase J, van der Kolk BM, van Laarhoven CJ, Luyer MD, Molenaar IQ, Patijn GA, Rupert CG, Scheepers JJ, van der Schelling GP, Vahrmeijer AL, Busch ORC, van Santvoort HC, Groot Koerkamp B, Besselink MG, Dutch Pancreatic Cancer Group (2018) Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit. HPB (Oxford) 20:759–767CrossRef
2.
Pedrazzoli S (2017) Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): a systematic review and analysis of the POPF-related mortality rate in 60,739 patients retrieved from the English literature published between 1990 and 2015. Medicine (Baltimore) 96:e6858CrossRef
3.
Sánchez-Velázquez P, Muller X, Malleo G, Park JS, Hwang HK, Napoli N, Javed AA, Inoue Y, Beghdadi N, Kalisvaart M, Vigia E, Walsh CD, Lovasik B, Busquets J, Scandavini C, Robin F, Yoshitomi H, Mackay TM, Busch OR, Hartog H, Heinrich S, Gleisner A, Perinel J, Passeri M, Lluis N, Raptis DA, Tschuor C, Oberkofler CE, DeOliveira ML, Petrowsky H, Martinie J, Asbun H, Adham M, Schulick R, Lang H, Koerkamp BG, Besselink MG, Han HS, Miyazaki M, Ferrone CR, Fernández-Del Castillo C, Lillemoe KD, Sulpice L, Boudjema K, Del Chiaro M, Fabregat J, Kooby DA, Allen P, Lavu H, Yeo CJ, Barroso E, Roberts K, Muiesan P, Sauvanet A, Saiura A, Wolfgang CL, Cameron JL, Boggi U, Yoon DS, Bassi C, Puhan MA, Clavien PA (2019) Benchmarks in pancreatic surgery: a novel tool for unbiased outcome comparisons. Ann Surg 270:211–218PubMedCrossRef
4.
Daamen LA, Smits FJ, Besselink MG, Busch OR, Borel Rinkes IH, van Santvoort HC, Molenaar IQ, Dutch Pancreatic Cancer Group (2018) A web-based overview, systematic review and meta-analysis of pancreatic anastomosis techniques following pancreatoduodenectomy. HPB (Oxford) 20:777–785CrossRef
5.
Hashimoto D, Chikamoto A, Ohmuraya M, Baba H (2014) Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy. Surg Today 44:1207–1213PubMedCrossRef
6.
Wang W, Zhang Z, Gu C, Liu Q, Liang Z, He W (2018) The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy: a network meta-analysis of randomized control trials. Int J Surg 57:111–116PubMedCrossRef
7.
Orci LA, Oldani G, Berney T, Andres A, Mentha G, Morel P, Toso C (2014) Systematic review and meta-analysis of fibrin sealants for patients undergoing pancreatic resection. HPB (Oxford) 16:3–11CrossRef
8.
Gong J, He S, Cheng Y, Cheng N, Gong J, Zeng Z (2018) Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery. Cochrane Database Syst Rev 6:CD009621PubMed
9.
Klempa I, Schwedes U, Usadel KH (1979) Prevention of postoperative pancreatic complications following duodenopancreatectomy using somatostatin. Chirurg 50:427–431PubMed
10.
Adiamah A, Arif Z, Berti F, Singh S, Laskar N, Gomez D (2019) The use of prophylactic somatostatin therapy following pancreaticoduodenectomy: a meta-analysis of randomised controlled trials. World J Surg 43:1788–1801PubMedCrossRef
11.
Roder JD, Stein HJ, Böttcher KA, Busch R, Heidecke CD, Siewert JR (1999) Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann Surg 229:41–48PubMedPubMedCentralCrossRef
12.
Ecker BL, McMillan MT, Asbun HJ, Ball CG, Bassi C, Beane JD, Behrman SW, Berger AC, Dickson EJ, Bloomston M, Callery MP, Christein JD, Dixon E, Drebin JA, Castillo CF, Fisher WE, Fong ZV, Haverick E, Hollis RH, House MG, Hughes SJ, Jamieson NB, Javed AA, Kent TS, Kowalsky SJ, Kunstman JW, Malleo G, Poruk KE, Salem RR, Schmidt CR, Soares K, Stauffer JA, Valero V, LKP V, Watkins AA, Wolfgang CL, Zureikat AH, Vollmer CM Jr (2018) Characterization and optimal management of high-risk pancreatic anastomoses during pancreatoduodenectomy. Ann Surg 267:608–616PubMedCrossRef
13.
Nahm CB, Connor SJ, Samra JS, Mittal A (2018) Postoperative pancreatic fistula: a review of traditional and emerging concepts. Clin Exp Gastroenterol 11:105–118PubMedPubMedCentralCrossRef
14.
Correa-Gallego C, Brennan MF, Dʼangelica M, Fong Y, Dematteo RP, Kingham TP, Jarnagin WR, Allen PJ (2013) Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution. Ann Surg 258:1051–1058PubMedCrossRef
15.
16.
Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214PubMedCrossRef
17.
Villafane-Ferriol N, Baugh KA, McElhany AL, Van Buren G 2nd, Fang A, Tashakori EK, Reyes JEM, Cao HST, Silberfein EJ, Massarweh N, Hsu C, Barakat O, Schmidt C, Zyromski NJ, Dillhoff M, Villarreal JA, Fisher WE (2019) Evidence versus practice in early drain removal after pancreatectomy. J Surg Res 236:332–339PubMedPubMedCentralCrossRef
18.
19.
Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493 discussion 493-494PubMedPubMedCentralCrossRef
20.
Van Buren G 2nd, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, Vollmer C, Velanovich V, Riall T, Muscarella P, Trevino J, Nakeeb A, Schmidt CM, Behrns K, Ellison EC, Barakat O, Perry KA, Drebin J, House M, Abdel-Misih S, Silberfein EJ, Goldin S, Brown K, Mohammed S, Hodges SE, McElhany A, Issazadeh M, Jo E, Mo Q, Fisher WE (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259:605–612PubMedCrossRef
21.
Diener MK, Tadjalli-Mehr K, Wente MN, Kieser M, Büchler MW, Seiler CM (2011) Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Arch Surg 396:41–52CrossRef
22.
van der Wilt AA, Coolsen MM, de Hingh IH, van der Wilt GJ, Groenewoud H, Dejong CH, van Dam RM (2013) To drain or not to drain: a cumulative meta-analysis of the use of routine abdominal drains after pancreatic resection. HPB (Oxford) 15:337–344CrossRef
23.
Dou CW, Liu ZK, Jia YL, Zheng X, Tu KS, Yao YM, Liu QG (2015) Systematic review and meta-analysis of prophylactic abdominal drainage after pancreatic resection. World J Gastroenterol 21:5719–5734PubMedPubMedCentralCrossRef
24.
Peng S, Cheng Y, Yang C, Lu J, Wu S, Zhou R, Cheng N (2015) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 8:CD010583
25.
Wang YC, Szatmary P, Zhu JQ, Xiong JJ, Huang W, Gomatos I, Nunes QM, Sutton R, Liu XB (2015) Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: a systematic review and meta-analysis. World J Gastroenterol 21:2510–2521PubMedPubMedCentralCrossRef
26.
Hüttner FJ, Probst P, Knebel P, Strobel O, Hackert T, Ulrich A, Büchler MW, Diener MK (2017) Meta-analysis of prophylactic abdominal drainage in pancreatic surgery. Br J Surg 104:660–668PubMedCrossRef
27.
Huan L, Fei Q, Lin H, Wan L, Li Y (2017) Is peritoneal drainage essential after pancreatic surgery? A meta-analysis and systematic review. Medicine (Baltimore) 96:e9245CrossRef
28.
Schorn S, Nitsche U, Demir IE, Scheufele F, Tieftrunk E, Schirren R, Klauss S, Sargut M, Ceyhan GO, Friess H (2018) The impact of surgically placed, intraperitoneal drainage on morbidity and mortality after pancreas resection- a systematic review & meta-analysis. Pancreatology 18:334–345PubMedCrossRef
29.
Zhang W, He S, Cheng Y, Xia J, Lai M, Cheng N, Liu Z (2018) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 6:CD010583PubMed
30.
Villafane-Ferriol N, Shah RM, Mohammed S, Van Buren G 2nd, Barakat O, Massarweh NN, Tran Cao HS, Silberfein EJ, Hsu C, Fisher WE (2018) Evidence-based management of drains following pancreatic resection: a systematic review. Pancreas 47:12–17PubMedCrossRef
31.
Linnemann RJA, Patijn GA, van Rijssen LB, Besselink MG, Mungroop TH, de Hingh IH, Kazemier G, Festen S, de Jong KP, van Eijck CHJ, Scheepers JJG, van der Kolk M, Dulk MD, Bosscha K, Busch OR, Boerma D, van der Harst E, Nieuwenhuijs VB, Dutch Pancreatic Cancer Group (2019) The role of abdominal drainage in pancreatic resection - a multicenter validation study for early drain removal. Pancreatology 19:888–896PubMedCrossRef
32.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef
33.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591PubMedCrossRef
34.
Smits FJ, Molenaar IQ, Besselink MG, Borel Rinkes IHM, van Eijck CHJ, Busch OR, van Santvoort HC, Dutch Pancreatic Cancer Group (2020) Early recognition of clinically relevant postoperative pancreatic fistula: a systematic review. HPB (Oxford) 22:1–11CrossRef
35.
36.
Smits FJ, van Santvoort HC, Besselink MG, Batenburg MCT, Slooff RAE, Boerma D, Busch OR, Coene PPLO, van Dam RM, van Dijk DPJ, van Eijck CHJ, Festen S, van der Harst E, de Hingh IHJT, de Jong KP, Tol JAMG, Borel Rinkes IHM, Molenaar IQ, Dutch Pancreatic Cancer Group (2017) Management of severe pancreatic fistula after pancreatoduodenectomy. JAMA Surg 152:540–548PubMedPubMedCentralCrossRef
37.
Baker TA, Aaron JM, Borge M, Pierce K, Shoup M, Aranha GV (2008) Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg 195:386–390 discussion 390PubMedCrossRef
38.
Pedrazzoli S, Liessi G, Pasquali C, Ragazzi R, Berselli M, Sperti C (2009) Postoperative pancreatic fistulas: preventing severe complications and reducing reoperation and mortality rate. Ann Surg 249:97–104PubMedCrossRef
39.
Satoi S, Toyokawa H, Yanagimoto H, Yamamoto T, Yamao J, Kim S, Matsui Y, Takai S, Mergental H, Kamiyama Y (2008) A new guideline to reduce postoperative morbidity after pancreaticoduodenectomy. Pancreas 37:128–133PubMedCrossRef
40.
Liang TB, Bai XL, Zheng SS (2007) Pancreatic fistula after pancreaticoduodenectomy: diagnosed according to International Study Group Pancreatic Fistula (ISGPF) definition. Pancreatology 7:325–331PubMedCrossRef
41.
Bressan AK, Wahba M, Dixon E, Ball CG (2018) Completion pancreatectomy in the acute management of pancreatic fistula after pancreaticoduodenectomy: a systematic review and qualitative synthesis of the literature. HPB (Oxford) 20:20–27CrossRef
42.
Zhou YM, Zhou X, Wan T, Xu D, Si XY (2018) An evidence-based approach to the surgical interventions for severe pancreatic fistula after pancreatoduodenectomy. Surgeon 16:119–124PubMedCrossRef
43.
Floortje van Oosten A, Smits FJ, van den Heuvel DAF, van Santvoort HC, Molenaar IQ (2019) Diagnosis and management of postpancreatectomy hemorrhage: a systematic review and meta-analysis. HPB (Oxford) 21:953–961CrossRef
44.
Ma T, Bai X, Chen W, Lao M, Jin G, Zheng K, Fu D, Yang F, Qin R, Li X, Lou W, Zhang L, Jiang K, Wu P, Shao C, Liu A, Yang Y, Ma Y, Wu H, Liang T (2019) Surgical management and outcome of grade-C pancreatic fistulas after pancreaticoduodenectomy: a retrospective multicenter cohort study. Int J Surg 68:27–34PubMedCrossRef
45.
Boverie JH, Remont A (1990) Percutaneous management of fistulas in the digestive tract. In: Dondelinger RF, Rossi P, Kurdziel JC et al (eds) Interventional radiology. Georg Thieme Verlag, Stuttgart, pp 746–752
46.
D'Harcour JB, Boverie JH, Dondelinger RF (1996) Percutaneous management of enterocutaneous fistulas. AJR Am J Roentgenol 167:33–38PubMedCrossRef
47.
Futagawa Y, Imazu H, Mori N, Kanazawa K, Chiba M, Furukawa K, Sakamoto T, Shiba H, Yanaga K (2017) The effectiveness and feasibility of endoscopic ultrasound-guided transgastric drainage of postoperative fluid collections early after pancreatic surgery. Surg Laparosc Endosc Percutan Tech 27:267–272PubMedCrossRef
48.
Al Efishat M, Attiyeh MA, Eaton AA, Gönen M, Covey AM, D'Angelica MI, DeMatteo RP, Kingham TP, Balachandran V, Jarnagin WR, Gerdes H, Allen PJ, Schattner MA (2019) Endoscopic versus percutaneous drainage of post-operative peripancreatic fluid collections following pancreatic resection. HPB (Oxford) 21:434–443CrossRef
49.
De Pastena M, Paiella S, Marchegiani G, Malleo G, Ciprani D, Gasparini C, Secchettin E, Salvia R, Bassi C (2017) Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: results from a high-volume center. Surgery 162:792–801PubMedCrossRef
50.
Yang F, Jin C, Li J, Di Y, Zhang J, Fu D (2018) Clinical significance of drain fluid culture after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 25:508–517PubMedCrossRef
51.
Tomimaru Y, Tanaka K, Noguchi K, Noura SO, Imamura H, Iwazawa T, Dono K (2020) Significance of fistulography findings to the healing time of postoperative pancreatic fistula after pancreaticoduodenectomy. Surg Today 50:577–584PubMedCrossRef
52.
Takeda Y, Saiura A, Inoue Y, Mise Y, Ishizawa T, Takahashi Y, Ito H (2020) Early fistulography can predict whether biochemical leakage develops to clinically relevant postoperative pancreatic fistula. World J Surg 44:1252–1259PubMedCrossRef
53.
Urbach DR, Kennedy ED, Cohen MM (1999) Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 229:174–180PubMedPubMedCentralCrossRef
54.
Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240:1074–1084 discussion 1084-1085PubMedPubMedCentralCrossRef
55.
Wang Z, Chen J, Su K, Dong Z (2015) Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev 5:CD008788
56.
Witzigmann H, Diener MK, Kienkötter S, Rossion I, Bruckner T, Werner B, Pridöhl O, Radulova-Mauersberger O, Lauer H, Knebel P, Ulrich A, Strobel O, Hackert T, Büchler MW (2016) No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg 264:528–537PubMedCrossRef
57.
Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216:1–14PubMedCrossRef
58.
Miller BC, Christein JD, Behrman SW, Drebin JA, Pratt WB, Callery MP, Vollmer CM Jr (2014) A multi-istitutional external validation of the fistula risk score for pancreatoduodenectomy. J Gastrointest Surg 18:172–179 discussion 179-180PubMedCrossRef
59.
McMillan MT, Fisher WE, Van Buren G 2nd, McElhany A, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, Velanovich V, Brown K, Morgan KA, Vollmer C (2015) The value of drains as a fistula mitigation strategy for pancreatoduodenectomy: something for everyone? Results of a randomized prospective multi-institutional study. J Gastrointest Surg 19:21–30 discussion 30-31PubMedCrossRef
60.
Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Yamaue H (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 244:1–7PubMedPubMedCentralCrossRef
61.
McMillan MT, Malleo G, Bassi C, Allegrini V, Casetti L, Drebin JA, Esposito A, Landoni L, Lee MK, Pulvirenti A, Roses RE, Salvia R, Vollmer CM Jr (2017) Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg 265:1209–1218PubMedCrossRef
62.
Trudeau MT, Maggino L, Chen B, McMillan MT, Lee MK, Roses R, DeMatteo R, Drebin JA, Vollmer CM Jr (2020) Extended experience with a dynamic, data-driven selective drain management protocol in pancreaticoduodenectomy: progressive risk stratification for better practice. J Am Coll Surg 230:809–818PubMedCrossRef
Metadata
Title
Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management
Authors
Sergio Pedrazzoli
Alessandra R. Brazzale
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 8/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-020-02005-8

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