Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2510-2521
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2510
Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: A systematic review and meta-analysis
Yi-Chao Wang, Peter Szatmary, Jing-Qiang Zhu, Jun-Jie Xiong, Wei Huang, Ilias Gomatos, Quentin M Nunes, Robert Sutton, Xu-Bao Liu
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Peter Szatmary, Wei Huang, Ilias Gomatos, Quentin M Nunes, Robert Sutton, NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, L69 3GA Liverpool, United Kingdom
Jun-Jie Xiong, Xu-Bao Liu, Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang YC and Szatmary P contributed equally to this work; Zhu JQ, Liu XB and Sutton R designed the research, and corrected and approved the manuscript; Wang YC, Szatmary P, Xiong JJ, Huang W, Gomatos I and Nunes QM developed the literature search and carried out statistical analysis of the studies; Wang YC, Szatmary P, Xiong JJ and Huang W performed data extraction; Wang YC and Szatmary P wrote the manuscript; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jing-Qiang Zhu, MD, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, Sichuan Province, China. jingqiangzhu@163.com
Telephone: +86-28-85422469 Fax: +86-28-85422872
Received: June 17, 2014
Peer-review started: June 17, 2014
First decision: July 9, 2014
Revised: July 26, 2014
Accepted: September 19, 2014
Article in press: September 19, 2014
Published online: February 28, 2015
Processing time: 256 Days and 0.5 Hours
Abstract

AIM: To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage.

METHODS: Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared between patients with and those without routine drainage. Pooled odds ratios (OR) with 95%CI were calculated using either fixed effects or random effects models.

RESULTS: One randomized controlled trial and four non-randomized comparative studies recruiting 1728 patients were analyzed. Patients without prophylactic drainage after PD had significantly higher mortality (OR = 2.32, 95%CI: 1.11-4.85; P = 0.02), despite the fact that they were associated with fewer overall complications (OR = 0.62, 95%CI: 0.48-0.82; P = 0.00), major complications (OR = 0.75, 95%CI: 0.60-0.93; P = 0.01) and readmissions (OR = 0.77, 95%CI: 0.60-0.98; P = 0.04). There were no significant differences in the rates of pancreatic fistula, intra-abdominal abscesses, postpancreatectomy hemorrhage, biliary fistula, delayed gastric emptying, reoperation or radiologic-guided drains between the two groups.

CONCLUSION: Indiscriminate abandonment of intra-abdominal drainage following PD is associated with greater mortality, but lower complication rates. Future randomized trials should compare routine vs selective drainage.

Keywords: Pancreaticoduodenectomy; Drain; Meta-analysis; Morbidity; Postoperative pancreatic fistula

Core tip: Routine prophylactic drainage remains standard practice following pancreaticoduodenectomy (PD) due to concerns that abandoning this would not be safe. Existing studies provide limited evidence regarding prophylactic drainage following PD. A systematic review addressing postoperative drainage following PD is therefore required. This study clarified that indiscriminate abandonment of intra-abdominal drainage following PD is associated with greater mortality, but lower overall and major complication rates. However, future randomized trials are needed to compare routine vs selective drainage.