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Background:
Prophylactic intraperitoneal closed-suction drains after pancreaticoduodenectomy (PD) are widely used even though its value is not well determined due to the limited number of studies available to date. The main objective of this study is to analyze the risk-benefit association of prophylactic drainage after PD.
Methods:
This is a retrospective cohort study of 635 patients who underwent a PD from January 1, 2000 to December 31, 2010. Analyses of the clinical, pathological and surgical outcomes of patients who had a closed-suction drain placed during PD were compared to those patients without drain.
Results:
Median age was 63 years (17 to 84). The majority of PD were performed for periampullary cancer (547/635, 86%) with 258/635, 40.7% pancreatic adenocarcinomas. There were 368/635, 58% patients in the drain group and 267/635, 42% without drain. During the first 6 years of the cohort, 160/190, 84% patients had a drain placed during PD vs. 253/445, 57% in the last 6 years, odds ratio (OR) 3.9, 95% confidence interval (CI): 2.5 to 6.3; p<0.01. Demographic, surgical and pathologic characteristics were similar between groups. There was no difference in the overall complication rate (278/635, 43.8%; 45.7 vs. 42.2; p=0.4), major complication rate / Clavien-Dindo Class ≥3 (110/635, 17.3%; 18.2 vs. 14.7; p=0.3), 90-day / in-hospital mortality rate (8/635, 1.3%; 1.1 vs. 1.4; p=0.7) and pancreatic leak rate (50/368, 12.1%; 13.6% vs. 10.1%; p=0.18. Patients with a diagnosis of pancreatic cancer had a much lower pancreatic leak rate compared to patients without pancreatic cancer, 5.6% vs. 16.4%, OR 3.3, 95% CI: 1.8 to 6.6; p<0.01; without any difference in the percentage of patients that had a drain placed in this group (65% vs. 59%; p=0.1). Median length of hospital stay was longer for the drain group, (10 vs. 9 days, p = 0.04); also, patients with drain that developed a complication had a significantly longer hospital stay than those without drain who also developed a complication (20 vs. 16 days, p = 0.04). Intraperitoneal drainage did not alter the risk of wound infection (67/635, 10.8%, 11.3 vs. 9.2; p=0.4), intra-abdominal abscess (79/635, 14.3%, 15.3 vs. 11.2; p=0.1), re-intervention (69/635, 12.2%, 12.7 vs. 10.6; p=0.4) or reoperation (16/635, 3.4%, 3.3 vs. 1.8; p=0.2) after PD.
Conclusion:
The use of prophylactic intraperitoneal closed-suction drains does not alter the postoperative complication or mortality rate after PD. The similar pancreatic leak and intra-abdominal abscess rate along with the comparable risk of postoperative interventional radiology drainage or surgical exploration between groups suggests that there is no increased benefit from the use of prophylactic closed-suction drainage after PD, therefore its role warrants further discussion.