• 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, van Eijck C H J CHJ Erasmus Medical Center, Department of Surgery, Rotterdam, the Netherlands., Scheepers J J G JJG Reinier de Graaf Hospital, Department of Surgery, Delft, the Netherlands., M van der Kolk, Dulk M den MD Maastricht University Medical Center, Department of Surgery, Maastricht, the Netherlands., K Bosscha, O R Busch, D Boerma, E van der Harst, V B Nieuwenhuijs, and Dutch Pancreatic Cancer Group.
• Isala, Department of Surgery, Zwolle, the Netherlands.
• Pancreatology. 2019 Sep 1; 19 (6): 888-896.

BackgroundAbdominal 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.MethodsPatients 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).ResultsAmong 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).ConclusionOur 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.Copyright © 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.

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