• Kenichiro Uemura, Yoshiaki Murakami, Takeshi Sudo, Yasushi Hashimoto, Naru Kondo, Naoya Nakagawa, Hayato Sasaki, Hiroki Ohge, and Taijiro Sueda.
• Department of Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
• J Surg Oncol. 2014 Jun 1;109(7):702-7.

BackgroundThe indicators for proper drain management following pancreaticoduodenectomy (PD) remain unclear. Our aim was to identify appropriate timing and proper indicators for safe drain management after PD.MethodsProspectively collected data from 200 patients who underwent PD were evaluated. Postoperative clinical factors for clinically relevant pancreatic fistulas (CR-POPFs) and management of surgically placed drains were analyzed retrospectively.ResultsCR-POPFs occurred in 8% of patients. By logistic regression analysis, one factor (non-serous fluid in the drain) on postoperative day (POD) 1 and two factors (non-serous fluid in the drain and serum CRP levels) on POD 3 and 4 were significantly associated with CR-POPFs. Receiver operating characteristic analysis demonstrated that combined predictive factors on POD 4 were the most accurate. Of 163 patients with serous fluid in the drain and CRP <15.6 mg/dl on POD 4, 1% had CR-POPFs, but no patient required POPF-related re-drainage. In contrast, among 37 patients with non-serous fluid in the drain or CRP levels ≥15.6 mg/dl, 35% had CR-POPFs, and 8% required POPF-related re-drainage.ConclusionsA combination of CRP levels and the color of surgical drain fluid, not POD1 or 3, but on POD 4, may be the most accurate indicators for safe drain management following PD.© 2014 Wiley Periodicals, Inc.

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