Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5719-5734
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5719
Systematic review and meta-analysis of prophylactic abdominal drainage after pancreatic resection
Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu
Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Dou CW, Liu ZK, Zheng X, Tu KS, Yao YM and Liu QG designed the research; Dou CW, Liu ZK and Jia YL performed the research; Dou CW, Liu ZK and Zheng X analyzed the data; Dou CW, Liu ZK and Zheng X wrote the paper; Dou CW and Liu ZK contributed equally to this article.
Supported by National Natural Scientific Foundation of China (No. 81272645 and No. 81072052 to Liu QG, and No. 81301743 to Zheng X); Research Fund for the Doctoral Program of High Education of China from Ministry of Education, (No. 20120201120090 to Zheng X).
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qing-Guang Liu, PhD, MD, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, Shaanxi Province, China. dcwtmac@sina.cn
Telephone: +86-29-85323905 Fax: +86-29-85323209
Received: October 10, 2014
Peer-review started: October 10, 2014
First decision: November 14, 2014
Revised: November 30, 2014
Accepted: December 19, 2014
Article in press: January 5, 2015
Published online: May 14, 2015
Processing time: 220 Days and 14.9 Hours
Abstract

AIM: To investigate whether prophylactic abdominal drainage is necessary after pancreatic resection.

METHODS: PubMed, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published before January 2014. Publications were retrieved if they met the selection criteria. The outcomes of interest included: mortality, morbidity, postoperative pancreatic fistula (POPF), clinically relevant pancreatic fistula (CR-PF), abdominal abscess, reoperation rate, the rate of interventional radiology drainage, and the length of hospital stay. Subgroup analyses were also performed for pancreaticoduodenectomy (PD) and for distal pancreatectomy. Begg’s funnel plot and the Egger regression test were employed to assess potential publication bias.

RESULTS: Nine eligible studies involving a total of 2794 patients were identified and included in this meta-analysis. Of the included patients, 1373 received prophylactic abdominal drainage. A fixed-effects model meta-analysis showed that placement of prophylactic drainage did not have beneficial effects on clinical outcomes, including morbidity, POPF, CR-PF, reoperation, interventional radiology drainage, and length of hospital stay (Ps > 0.05). In addition, prophylactic drainage did not significantly increase the risk of abdominal abscess. Overall analysis showed that omitting prophylactic abdominal drainage resulted in higher mortality after pancreatectomy (OR = 1.56; 95%CI: 0.93-2.92). Subgroup analysis of PD showed similar results to those in the overall analysis. Elimination of prophylactic abdominal drainage after PD led to a significant increase in mortality (OR = 2.39; 95%CI: 1.22-4.69; P = 0.01).

CONCLUSION: Prophylactic abdominal drainage after pancreatic resection is still necessary, though more evidence from randomized controlled trials assessing prophylactic drainage after PD and distal pancreatectomy are needed.

Keywords: Prophylactic abdominal drainage; Pancreatic resection; Systemic review; Meta-analysis

Core tip: The elimination of prophylactic abdominal drainage resulted in an increase in mortality rate after pancreatic resection, especially in patients who underwent pancreaticoduodenectomy (PD). Therefore, prophylactic abdominal drainage is still necessary after pancreatic resection. Randomized controlled trials assessing the value of prophylactic abdominal drainage after PD and distal pancreatectomy are required to provide more powerful evidence. Based on current evidence, future prophylactic abdominal drainage may not be routine due to advances in surgical techniques and perioperative management. Moreover, drainage strategy after pancreatic resection should be tailored based on the characteristics of each patient.