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