title: Indicators of complications and drain removal after pancreatoduodenectomy.
abstract: BACKGROUND
  Significance and timing of drain removal after pancreatic surgery remain unclear. The aim of this study was to identify optimal indicators to predict severe intra-abdominal complications and determine the appropriate timing of prophylactic drain removal after pancreatoduodenectomy.
  
  
  METHODS
  This study included 151 consecutive patients who underwent pancreatoduodenectomy. We investigated associations between postoperative intra-abdominal complications, drain amylase levels, and duration of postoperative inflammatory response.
  
  
  RESULTS
  Patients who developed severe intra-abdominal complications showed re-elevation of drain amylase levels after postoperative d 3 and prolonged postoperative inflammatory response, which were most pronounced in patients with severe pancreatic fistula and intra-abdominal abscess, respectively. In contrast, patients with a steady decline in drain amylase levels and short-term postoperative inflammatory response did not develop severe complications, and safe drain removal was possible even when the drain amylase value was more than three times the upper limit of normal serum amylase.
  
  
  CONCLUSIONS
  A combination of trends in the drain amylase level and duration of the inflammatory response in the postoperative period may be optimal indicators for early detection of severe intra-abdominal complications and appropriate timing of drain removal.
authors.affiliation: Department of Surgical Oncology and Digestive Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan. h-krhr@m3.kufm.kagoshima-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurahara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mataki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iino
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sakoda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Sonshin
authors.initials: S
authors.lastname: Takao
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000378:metabolism; D020878:Device Removal / Q000009:adverse effects* / Q000706:statistics & numerical data; D004322:Drainage / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000453:epidemiology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D000681:Amylases