Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis

Introduction: There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG)and closed-suction drainage (CSD)following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. Methods: The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF)rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT)was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model)with odds ratios and 95% confidence intervals (OR (95%CI))as an effect measure was utilized. Results: Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD)were included. In meta-analysis of all studies, overall [OR (95%CI)= 0.81 (0.42, 1.56); p = 0.53; I ² = 79%; Tau ² = 0.54]; grade A [OR (95%CI)= 0.71 (0.33, 1.53); p = 0.39; I ² = 65%; Tau ² = 0.47]; grade B [OR (95%CI)= 1.23 (0.74, 2.05); p = 0.42; I ² = 0%]; and grade C [OR (95%CI)= 1.08 (0.56, 2.09); p = 0.82; I ² = 5%]POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI)= 1.55 (0.79, 3.04); p = 0.20; I ² = 0%]. No publication bias was found (t = 0.48; p = 0.64). Conclusion: This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.