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Purpose <p>Postoperative pancreatic fistula (POPF) remains a major complication following pancreaticoduodenectomy (PD). Although pancreaticogastrostomy (PG) has been suggested to be associated with a lower risk of POPF in some studies, optimal criteria for postoperative drain management in PG cases remain unclear.</p> Methods <p>This single-institution retrospective study analyzed 195 consecutive PD cases involving a soft pancreas and PG. New criteria for safe drain removal were developed based on independent risk factors identified through a multivariate analysis. A prospective validation study was then conducted in 70 consecutive soft pancreas cases to assess the safety and efficacy of these criteria.</p> Results <p>In the retrospective cohort, white blood cell count (WBC) &gt; 8200/µL on postoperative day (POD) 5, drain fluid amylase (DFA) &gt; 160 U/L on POD 5, and delayed nasogastric (NG) tube removal were identified as independent risk factors. The criteria for drain removal were defined as: WBC ≤ 8200/µL, DFA ≤ 160 U/L, and NG tube removal by POD5. In the validation cohort, 42 out of 70 patients met the criteria; none developed Clavien–Dindo grade IIIa or higher complications after drain removal. The incidence of delayed gastric emptying (DGE) was significantly lower in the post-validation cohort than in the pre-validation cohort (<i>p</i> &lt; 0.01).</p> Conclusion <p>In patients undergoing PG with a soft pancreas, application of the new criteria enables safe early drain removal and may help reduce the incidence of DGE.</p>

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Development of novel criteria for drain removal after pancreaticogastrostomy in pancreaticoduodenectomy: a retrospective analysis and validation study at a single institution

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月1日

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  • Hisashi Murakami,
  • Satoshi Okubo,
  • Takuma Okada,
  • Masaru Matsumura,
  • Junichi Shindoh,
  • Masaji Hashimoto

摘要

Purpose

Postoperative pancreatic fistula (POPF) remains a major complication following pancreaticoduodenectomy (PD). Although pancreaticogastrostomy (PG) has been suggested to be associated with a lower risk of POPF in some studies, optimal criteria for postoperative drain management in PG cases remain unclear.

Methods

This single-institution retrospective study analyzed 195 consecutive PD cases involving a soft pancreas and PG. New criteria for safe drain removal were developed based on independent risk factors identified through a multivariate analysis. A prospective validation study was then conducted in 70 consecutive soft pancreas cases to assess the safety and efficacy of these criteria.

Results

In the retrospective cohort, white blood cell count (WBC) > 8200/µL on postoperative day (POD) 5, drain fluid amylase (DFA) > 160 U/L on POD 5, and delayed nasogastric (NG) tube removal were identified as independent risk factors. The criteria for drain removal were defined as: WBC ≤ 8200/µL, DFA ≤ 160 U/L, and NG tube removal by POD5. In the validation cohort, 42 out of 70 patients met the criteria; none developed Clavien–Dindo grade IIIa or higher complications after drain removal. The incidence of delayed gastric emptying (DGE) was significantly lower in the post-validation cohort than in the pre-validation cohort (p < 0.01).

Conclusion

In patients undergoing PG with a soft pancreas, application of the new criteria enables safe early drain removal and may help reduce the incidence of DGE.