Early Removal Of Intra-abdominal Drains Reduce The Incidence Of Pancreatic Fistula After Pancreaticoduodenectomy

ObjectiveThere were small numbers of clinical trials at abroad which validated early removal of intra-abdominal drains reducing the incidence of POPF and some other complications after PD,but data was lacked at home.This retrospective case-control study from a single centre was designed to compare the short-term outcomes between early and late removal of intra-abdominal drains after PD,further more,to search for the cutoff value which could predict early POPF.MethodsBetween January 2013 and October 2015,a retrospective analysis of 430 patients who underwent PD in Southwest Hospital was carried out.Firstly,the patients who got early POPF were separated from the others who didn't;then the latter was divided into 2 groups by the removal time of intra-abdominal drains: group A(the time no more than POD5)and group B(the time beyond POD5),postoperative complications between the 2 groups were compared,and risk factors associated with POPF were evaluated by both univariate and multivariate analysis;lastly,the risk factors of early POPF following PD were analyzed in the total of 430 patients,and the cutoff value predicting early POPF was investigated by ROC curve.ResultsA total of 430 patients who underwent PD and met the inclusion criteria were analyzed,including 116 patients who got early POPF,9 patients got some other complications,and the rest got none.Group A with 98 patients versus group B with 207 patients in the cohort of the rest patients,there were no significant differences in rate of radiologic-guided drains,reoperation or death between the two groups(P > 0.05),but the incidence of POPF,abdominal infections and overall complications following PD all significantly reduced in group A comparing with group B(3.1%vs12.1%,9.2%vs20.3%,24.5%vs42.0%,P<0.05),length of stay after operation also decreased(13.0(4-44)vs15.5(9-64),P < 0.05),the independent risk factors associated with POPF coming from logistic regression analysis included: male,the diameter of the pancreatic duct<3mm,tumor coming from distal bile duct/duodenum/ampulla and the removal time of intra-abdominal drains > POD5(OR=4.424,2.369,3.874,5.028,P<0.05).After analyzing the total of 430 patients,it showed that both DFA1 and SA1 were independent risk factors of early POPF following PD(P=0.000,0.016),but DFA1 had better ability to predict it(AUC=0.916vs0.745,P<0.001),ROC curve ultimately confirmed that DFA1<494.75 IU/L indicated absence of early POPF with sensitivity,specificity,positive and negative predictive value 91.7 %,80.8%,62.7%,96.5%,respectively.ConclusionFor patient who got no early POPF following PD,removing intra-abdominal drains on POD5 didn't increase the rate of radiologic-guided drains,reoperation or death,conversely,it reduced the incidence of POPF,abdominal infections.Furthermore,if patient with DFA1<494.75 IU/L,it was safe to remove intra-abdominal drains on POD3 after PD.