Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level

摘要: Background/purpose Early drain removal (EDR) based on fluid amylase level (DFA) after pancreaticoduodenectomy excluded 15%-40% patients from EDR because of inappropriate DFA. Methods Of 198 pancreatoduodenectomy cases, we used the first 105 cases as an exploration cohort to construct optimal criteria for postoperative day (POD)4 that were applied subsequent 93 validation cohort. After that, examined another 142 further assess efficacy new criteria. Results four independent predictors clinically relevant pancreatic fistula (CR-POPF) ([1] soft pancreas, [2] positive culture POD1, and [3] serum C-reactive protein [CRP] ≥13 mg/dL POD4) in cohort, was meeting and/or [3], enabling 96% (89/93) applicability EDR. Outcomes improved compared cohort; CR-POPF: 8.6% vs 25.7%, P = .005; Dindo-Clavien grade ≥ 3 complications: 23.7% 41.9%, .007; median hospital stay (day): 21 27, .005. The showed 92% (131/142) 5.6% (8/142) incidence CR-POPF. Conclusions Our EDR, without DFA, enabled 90% reduced