Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2510
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
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.
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.