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

doi:10.1016/j.pan.2019.07.041

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 journal › Article › Academic › peer-review

Abstract

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 language	English
Pages (from-to)	888-896
Number of pages	9
Journal	Pancreatology
Volume	19
Issue number	6
DOIs	https://doi.org/10.1016/j.pan.2019.07.041
Publication status	Published - Sept 2019

Keywords

Whipple
PPPD
Pancreas
Drain
Fistula
INTRAPERITONEAL DRAINAGE
FISTULA
METAANALYSIS
TRIAL
PANCREATICODUODENECTOMY
RISK

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10.1016/j.pan.2019.07.041

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Linnemann, R. J. A., Patijn, G. A., van Rijssen, L. B., Besselink, M. G., Mungroop, T. H., de Hingh, I. H., Kazemier, G., Festen, S., de Jong, K. P., van Eijck, C. H. J., Scheepers, J. J. G., van der Kolk, M., den Dulk, M., Bosscha, K., Busch, O. R., Boerma, D., van der Harst, E., Nieuwenhuijs, V. B., & Dutch Pancreatic Canc Grp (2019). The role of abdominal drainage in pancreatic resection - A multicenter validation study for early drain removal. Pancreatology, 19(6), 888-896. https://doi.org/10.1016/j.pan.2019.07.041

@article{6b7f2ceec9eb48f9ab26f016e6e1cc83,

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

abstract = "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.",

keywords = "Whipple, PPPD, Pancreas, Drain, Fistula, INTRAPERITONEAL DRAINAGE, FISTULA, METAANALYSIS, TRIAL, PANCREATICODUODENECTOMY, RISK",

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

note = "Publisher Copyright: {\textcopyright} 2019 IAP and EPC",

year = "2019",

month = sep,

doi = "10.1016/j.pan.2019.07.041",

language = "English",

volume = "19",

pages = "888--896",

journal = "Pancreatology",

issn = "1424-3903",

publisher = "Elsevier",

number = "6",

}

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, den Dulk, M, Bosscha, K, Busch, OR, Boerma, D, van der Harst, E, Nieuwenhuijs, VB & Dutch Pancreatic Canc Grp 2019, 'The role of abdominal drainage in pancreatic resection - A multicenter validation study for early drain removal', Pancreatology, vol. 19, no. 6, pp. 888-896. https://doi.org/10.1016/j.pan.2019.07.041

TY - JOUR

T1 - The role of abdominal drainage in pancreatic resection - A multicenter validation study for early drain removal

AU - Linnemann, R. J. A.

AU - Patijn, G. A.

AU - van Rijssen, L. B.

AU - Besselink, M. G.

AU - Mungroop, T. H.

AU - de Hingh, I. H.

AU - Kazemier, G.

AU - Festen, S.

AU - de Jong, K. P.

AU - van Eijck, C. H. J.

AU - Scheepers, J. J. G.

AU - van der Kolk, M.

AU - den Dulk, M.

AU - Bosscha, K.

AU - Busch, O. R.

AU - Boerma, D.

AU - van der Harst, E.

AU - Nieuwenhuijs, V. B.

AU - Dutch Pancreatic Canc Grp

PY - 2019/9

Y1 - 2019/9

N2 - 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.

AB - 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.

KW - Whipple

KW - PPPD

KW - Pancreas

KW - Drain

KW - Fistula

KW - INTRAPERITONEAL DRAINAGE

KW - FISTULA

KW - METAANALYSIS

KW - TRIAL

KW - PANCREATICODUODENECTOMY

KW - RISK

U2 - 10.1016/j.pan.2019.07.041

DO - 10.1016/j.pan.2019.07.041

M3 - Article

C2 - 31378583

SN - 1424-3903

VL - 19

SP - 888

EP - 896

JO - Pancreatology

JF - Pancreatology

IS - 6

ER -