Abstract：
BACKGROUND: Early drain removal (EDR) has been widely accepted, but not been routinely used in patients after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). This study aimed to evaluate the safety and benefits of EDR versus routine drain removal (RDR) after PD or DP.
METHODS: A systematic search was conducted on medical search engines from January 1, 2008 to November 1, 2023, for articles that compared EDR versus RDR after PD or DP. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF). Further analysis of studies including patients with low-drain fluid amylase (low-DFA) on postoperative day 1 and defining EDR timing as within 3 days was also performed.
RESULTS: Four randomized controlled trials (RCTs) and eleven non-RCTs with a total of 9465 patients were included in this analysis. For the primary outcome, the EDR group had a significantly lower rate of CR-POPF (OR 0.23; p < 0.001). For the secondary outcomes, a lower incidence was observed in delayed gastric emptying (OR 0.63, p = 0.02), Clavien-Dindo III-V complications (OR 0.48, p < 0.001), postoperative hemorrhage (OR 0.55, p = 0.02), reoperation (OR 0.57, p < 0.001), readmission (OR 0.70, p = 0.003) and length of stay (MD -2.04, p < 0.001) in EDR. Consistent outcomes were observed in the subgroup analysis of low-DFA patients and definite EDR timing, except for postoperative hemorrhage in EDR.
CONCLUSIONS: EDR after PD or DP is beneficial and safe, reducing the incidence of CR-POPF and other postoperative complications. Further prospective studies and RCTs are required to validate this finding.
METHODS: A systematic search was conducted on medical search engines from January 1, 2008 to November 1, 2023, for articles that compared EDR versus RDR after PD or DP. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF). Further analysis of studies including patients with low-drain fluid amylase (low-DFA) on postoperative day 1 and defining EDR timing as within 3 days was also performed.
RESULTS: Four randomized controlled trials (RCTs) and eleven non-RCTs with a total of 9465 patients were included in this analysis. For the primary outcome, the EDR group had a significantly lower rate of CR-POPF (OR 0.23; p < 0.001). For the secondary outcomes, a lower incidence was observed in delayed gastric emptying (OR 0.63, p = 0.02), Clavien-Dindo III-V complications (OR 0.48, p < 0.001), postoperative hemorrhage (OR 0.55, p = 0.02), reoperation (OR 0.57, p < 0.001), readmission (OR 0.70, p = 0.003) and length of stay (MD -2.04, p < 0.001) in EDR. Consistent outcomes were observed in the subgroup analysis of low-DFA patients and definite EDR timing, except for postoperative hemorrhage in EDR.
CONCLUSIONS: EDR after PD or DP is beneficial and safe, reducing the incidence of CR-POPF and other postoperative complications. Further prospective studies and RCTs are required to validate this finding.
摘要：
背景：早期排水去除（EDR）已被广泛接受，但未在胰十二指肠切除术（PD）和远端胰腺切除术（DP）后的患者中常规使用。本研究旨在评估PD或DP后EDR与常规排水去除（RDR）的安全性和益处。
方法：于2008年1月1日至2023年11月1日在医学搜索引擎上进行了系统搜索，以查找比较PD或DP后EDR与RDR的文章。主要结果是临床相关的术后胰瘘（CR-POPF）。还对包括术后第1天低引流液淀粉酶（低DFA）患者和将EDR时间定义为3天内的研究进行了进一步分析。
结果：本分析包括4项随机对照试验（RCTs）和11项非RCTs，共9465例患者。对于主要结果，EDR组的CR-POPF发生率明显降低(OR0.23;p<0.001)。对于次要结果，在胃排空延迟中观察到较低的发生率（OR0.63，p=0.02），Clavien-DindoIII-V并发症（OR0.48，p<0.001），术后出血（OR0.55，p=0.02），再次手术（OR0.57，p<0.001），EDR的再入院率(OR0.70，p=0.003)和住院时间(MD-2.04，p<0.001)。在低DFA患者的亚组分析和明确的EDR时机中观察到一致的结果。除了EDR术后出血。
结论：PD或DP后的EDR是有益且安全的，降低CR-POPF等术后并发症的发生率。需要进一步的前瞻性研究和随机对照试验来验证这一发现。
方法：于2008年1月1日至2023年11月1日在医学搜索引擎上进行了系统搜索，以查找比较PD或DP后EDR与RDR的文章。主要结果是临床相关的术后胰瘘（CR-POPF）。还对包括术后第1天低引流液淀粉酶（低DFA）患者和将EDR时间定义为3天内的研究进行了进一步分析。
结果：本分析包括4项随机对照试验（RCTs）和11项非RCTs，共9465例患者。对于主要结果，EDR组的CR-POPF发生率明显降低(OR0.23;p<0.001)。对于次要结果，在胃排空延迟中观察到较低的发生率（OR0.63，p=0.02），Clavien-DindoIII-V并发症（OR0.48，p<0.001），术后出血（OR0.55，p=0.02），再次手术（OR0.57，p<0.001），EDR的再入院率(OR0.70，p=0.003)和住院时间(MD-2.04，p<0.001)。在低DFA患者的亚组分析和明确的EDR时机中观察到一致的结果。除了EDR术后出血。
结论：PD或DP后的EDR是有益且安全的，降低CR-POPF等术后并发症的发生率。需要进一步的前瞻性研究和随机对照试验来验证这一发现。
