Pancreatic surgery with or without drainage: propensity score-matched study.

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Research

Background:

• A randomized controlled trial indicated that routine intraoperative drain placement after pancreatoduodenectomy (PD) is not essential.
• This study aimed to validate these findings in a real-world clinical setting.

Purpose of the Study:

• To evaluate the impact of omitting intraoperative drains on patient outcomes after pancreatoduodenectomy (PD) and distal pancreatectomy (DP).
• To identify factors influencing the decision to use intraoperative drains in pancreatic surgery.

Main Methods:

• A propensity score-matched (PSM) analysis compared patients who had or did not have drains placed after PD or DP at a high-volume center.
• Outcomes assessed included complications and hospital stay duration. Multivariable regression identified predictors of drain placement.

Main Results:

• In PD patients (n=266), no drain was linked to fewer major complications (31.6% vs 46.6%), shorter hospital stays (14.7 vs 19.6 days), and reduced need for interventional drains (8.4% vs 19.8%).
• In DP patients (n=112), no drainage correlated with fewer pancreatic fistulas (9% vs 18%), lower overall complications (CCI 15.9 vs 24.8), and shorter hospital stays (9.3 vs 13.5 days).
• Multivisceral resection and longer operating times influenced drain use in PD; greater blood loss was associated with drainage in DP.

Conclusions:

• Standard pancreatic resections can be safely performed without intraoperative drains.
• Surgeons exhibited greater hesitation in omitting drains for more complex pancreatic resections.