The role of abdominal drainage in pancreatic resection - A multicenter validation study for early drain removal

R. J. A. Linnemann, G. A. Patijn, L. B. van Rijssen, M. G. Besselink, T. H. Mungroop, I. H. de Hingh, G. Kazemier, S. Festen, K. P. de Jong, C. H. J. van Eijck, J. J. G. Scheepers, M. van der Kolk, M. den Dulk, K. Bosscha, O. R. Busch, D. Boerma, E. van der Harst, V. B. Nieuwenhuijs*, Dutch Pancreatic Canc Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Abdominal drainage and the timing of drain removal in patients undergoing pancreatic resection are under debate. Early drain removal after pancreatic resection has been reported to be safe with a low risk for clinical relevant postoperative pancreatic fistula (CR-POPF) when drain amylase on POD1 is <5000U/L. The aim of this study was to validate this algorithm in a large national cohort.

Methods: Patients registered in the Dutch Pancreatic Cancer Audit (2014-2016) who underwent pancreatoduodenectomy, distal pancreatectomy or enucleation were analysed. Data on post-operative drain amylase levels, drain removal, postoperative pancreatic fistulae were collected. Univariate and multivariate analysis using a logistic regression model were performed. The primary outcome measure was grade B/C pancreatic fistula (CR-POPF).

Results: Among 1402 included patients, 433 patients with a drain fluid amylase level of <5000U/L on POD1, 7% developed a CR-POPF. For patients with an amylase level >5000U/L the CR-POPF rate was 28%. When using a cut-off point of 2000U/L or 1000U/L during POD1-3, the CR-POPF rates were 6% and 5% respectively. For patients with an amylase level of >2000U/L and >1000UL during POD 1-3 the CR-POPF rates were 26% and 22% respectively (n = 223). Drain removal on POD4 or thereafter was associated with more complications (p = 0.004). Drain amylase level was shown to be the most statistically significant predicting factor for CR-POPF (Wald = 49.7; p <0.001).

Conclusion: Our data support early drain removal after pancreatic resection. However, a cut-off of 5000U/L drain amylase on POD1 was associated with a relatively high CR-POPF rate of 7%. A cut-off point of 1000U/L during POD1-3 resulted in 5% CR-POPF and might be a safer alternative. (C) 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)888-896
Number of pages9
Issue number6
Publication statusPublished - Sept 2019


  • Whipple
  • PPPD
  • Pancreas
  • Drain
  • Fistula
  • RISK

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