Intra-abdominal drainage following pancreatic resection: A systematic review

Table 1 Main characteristics and results of studies comparing drain vs no drain, or selective drain use n (%)

Ref.	Year	Type of study	Type of resection, n	Type of drain	Groups, n	Age (yr), range	POPF	Morbidity	Reoperation	Operation time (min)	Blood loss (mL)	Hospital stay (d)
Jeekel et al[44]	1992	Pilot study	PD 22	NA	No drain n = 22	43-79	NA	5 (23)	1 (5)	NA	NA	NA
Heslin et al[43]	1998	Retrospective	PD 89	Closed-suction	Drain n = 51	65 ± 21	3 (6)	23 (45)	2 (4)	386 ± 201	1100 ± 101	12 ± 11
					No drain n = 38	65 ± 21	1 (3)	15 (39)	3 (8)	292 ± 131	1100 ± 101	12 ± 11
Conlon et al[13]	2001	RCT	PD 139/DP 40	Closed-suction (Jackson-Pratt)	Drain n = 88	66 (23-81)2	11 (13)	55 (63)	8 (9)	330/190	800/600	9 +
					No drain n = 91	69 (33-87)2	0 (0)	52 (57)	4 (4)	329/180	800/500	9 +
Fischer et al[15]	2011	Time cohort	PD 153, DP 73	Closed-suction	Drain n = 179	63 (53-72)3	79 (44)	117 (65)	8 (4)	401 (310-490)3	400 (200-700)3	7 (7-10)3
					No drain n = 47	59 (51-70)3	5 (11)	22 (47)	0 (0)	400 (314-458)3	250 (150-500)3	7 (6-8)3
Paulus et al[16]	2012	Retrospective	DP 69	Closed-suction (Jackson-Pratt or Blake)	Drain n = 39	52 (44-66)2	6 (15)	15 (50)	11 (28)	249 (196-290)2	450 (300-750)2	9 (7-17)2
					No drain n = 30	58 (52-68)2	0 (0)	20 (51)	8 (27)	195 (176-260)2	200 (100-300)2	6.5 (5-8)2
Lim et al[46]	2013	Selective	PD 54	Multichannel open silicone drain	Drain n = 27	62 (40-76)2	6 (22)	19 (70)	2 (7)	300 (180-540)2	400 (50-2000)2	15 (11-56)2
					No drain n = 27	62 (38-78)2	0 (0)	15 (56)	1 (4)	270 (170-420)2	300 (100-2000)2	10 (8-26)2
Mehta et al[47]	2013	Retrospective	709 PD	Closed-suction (Jackson-Pratt or Blake)	Drain n = 251	604	61 (24)	171 (68)	14 (6)	2944	5724	13.84
					No drain n = 458	62.54	48 (10)	248 (54)	26 (6)	2014	2824	11.34
Adham et al[11]	2013	Retrospective	148 PD, 66 DP, 20 CPR, 8 E	Closed-suction (shirley)	Drain n = 130	61.5 (20-85)2	21 (16)	83 (64)	16 (12)	235 ± 711	471 ± 5681	16 (2-98)2
					No drain n = 112	66.5 (19-85)2	14 (13)	45 (67)	17 (15)	265 ± 841	379 ± 3871	18 (7-131)2
Correa-Gallego et al[14]	2013	Retrospective	739 PD, 350 DP, 31 CPR, 2 CSP	Closed-suction (Jackson-Pratt)	Drain PD n = 386	65 ± 131	149 (27)	301 (54)	3 (< 1)	295 (250-339)3	525 (350-800)3	8 (7-11)3
					Drain DP n = 154					191 (154-229)3	400 (200-800)3	7 (6-9)3
					No drain PD n = 353		102 (18)	272 (48)	2 (< 1)	206 (180-247)3	400 (250-700)3	7 (6-10)3
					No drain DP n = 196					152 (118-188)3	200 (100-400)3	5 (5-7)3
Behrman et al[12]	2014	Propensity-score match cohort	232 DP	NA	Drain n = 116	57 +	25 (22)	50 (43)	1 (1)	222 +	NA	6 +
					no draín n = 116	59 +	8 (7)	35 (30)	3 (3)	228 +	NA	6 +
Kunstman et al[45]	2014	Routine non-drainer	265 PD	NA	Drain n = 6	64.24	21 (8)	220 (83)	NA	NA	NA	6 (3-8)3
					No drain n = 259
Van Buren et al[17]	2014	RCT	137 PD	Closed-suction	Drain n = 68	62 ± 121	21 (31)	50 (74)	2 (3)	425 ± 1511	460 ± 3521	7 (6-9)3
					No drain n = 69	64 ± 131	14 (20)	52 (75)	6 (9)	407 ± 1571	443 ± 3441	8 (7-14)3

¹mean ± SD;

²median (range);

³median (interquartile range);

⁴mean, + median. NA: Not available; RCT: Randomized controlled trial; PD: Pancreaticoduodenectomy; DP: Distal pancreatectomy; CPR: Central pancreatic resection; E: Enucleation; CSP: Central-sparing pancreatectomy.

Table 2 Main characteristics and results of studies evaluating timing of drain removal n (%)

Ref.	Year	Type of study	Type of resection, n	Type of drain	Groups, n	Age (yr)	Drain duration (d)	POPF	Morbidity	Reoperation	Op time (min)	Blood loss (mL)	Hospital stay (d)
Balzano et al[42]	2005	Retrospective	123 DP	Open silicone 28 CH drain	123	59 (19-85)2	36 ± 17 ++	42 (34)	60 (49)	5 (4)	246 ± 871	635 ± 5231	11.8 ± 6.11
Kawai et al[38]	2006	Time cohort	104 PD	10-mm Penrose (silicon multitubular flat drain)	52 early	66 ± 101	POD 4	2 (4)	19 (37)	0	407 ± 761	1270 ± 12201	42 ± 131
					52 late	67 ± 101	POD 8	12 (23)	35 (67)	0	383 ± 591	1287 ± 13741	35 ± 251
Bassi et al[37]	2010	RCT	75 PD, 39 DP	Flat penrose drain 12 mm	57 early	56 ± 141	POD 3	1 (2)	22 (39)	0	285 ± 971	NA	8.7 ± 41
					57 late	57 ± 131	POD after 5	15 (26)	35 (61)	1 (2)	291 ± 861	NA	10.8 ± 6.91

¹mean ± SD;

²median (range). ++: only patients with POPF. PD: Pancreaticoduodenectomy; DP: Distal pancreatectomy; RCT: Randomized controlled trial.

Table 3 Main characteristics and results of studies comparing different drain types n (%)

Ref.	Year	Type of study	Type of resection, n	Type of drain	Morbidity	POPF
Aimoto et al[36]	2008	Time cohort	33 PD	Duple drain (n = 14)	10 (71)	14 (100)
				Blake drain (n = 19)	2 (11)	19 (100)
Schmidt et al[48]	2009	Retrospective	510 PD	Penrose drain (n = 241)	241 (47)	8 (3)
				Closed-suction (n = 269)	269 (53)	38 (14)
Yoshikawa et al[49]	2011	Time cohort	97 DP	Penrose drain (n = 56)	56 (58)	40 (71)
				Closed-suction (n = 41)	41 (42)	26 (63)
Yui et al[50]	2014	Time cohort	109 DP	Penrose drain (n = 52)	28 (54)	22 (42)
				Closed-suction (n = 57)	25 (44)	15 (26)

PD: Pancreaticoduodenectomy; DP: Distal pancreatectomy.