Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula
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SYSTEMATIC REVIEWS AND META-ANALYSES
Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management Sergio Pedrazzoli 1
&
Alessandra R. Brazzale 2
Received: 6 May 2020 / Accepted: 29 September 2020 # The Author(s) 2020
Abstract Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPFrelated mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then metaanalyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management. Keywords Pancreas . Pancreatic surgery . Pancreaticoduodenectomy . Duodenopancreatectomy . Surgical drains . Pancreatic fistula
Introduction Both authors meet all four criteria for authorship stated by the guidelines of the International Committee of Medical Journal Editors (ICMJE). Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-02005-8) contains supplementary material, which is available to authorized users. * Sergio Pedrazzoli [email protected] 1
Università degli Studi di Padova, Via Crescini, 39, 35126 Padua, Italy
2
Dipartimento di Scienze Statistiche, Università degli Studi di Padova, Padua, Italy
Pancreatoduodenectomy (PD) has become safer over the p
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