title: Systematic review and meta-analysis of prophylactic abdominal drainage after pancreatic resection.
abstract: OBJECTIVE
  To investigate whether prophylactic abdominal drainage is necessary after pancreatic resection.
  
  
  METHODS
  PubMed, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published before January 2014. Publications were retrieved if they met the selection criteria. The outcomes of interest included: mortality, morbidity, postoperative pancreatic fistula (POPF), clinically relevant pancreatic fistula (CR-PF), abdominal abscess, reoperation rate, the rate of interventional radiology drainage, and the length of hospital stay. Subgroup analyses were also performed for pancreaticoduodenectomy (PD) and for distal pancreatectomy. Begg's funnel plot and the Egger regression test were employed to assess potential publication bias.
  
  
  RESULTS
  Nine eligible studies involving a total of 2794 patients were identified and included in this meta-analysis. Of the included patients, 1373 received prophylactic abdominal drainage. A fixed-effects model meta-analysis showed that placement of prophylactic drainage did not have beneficial effects on clinical outcomes, including morbidity, POPF, CR-PF, reoperation, interventional radiology drainage, and length of hospital stay (Ps > 0.05). In addition, prophylactic drainage did not significantly increase the risk of abdominal abscess. Overall analysis showed that omitting prophylactic abdominal drainage resulted in higher mortality after pancreatectomy (OR = 1.56; 95%CI: 0.93-2.92). Subgroup analysis of PD showed similar results to those in the overall analysis. Elimination of prophylactic abdominal drainage after PD led to a significant increase in mortality (OR = 2.39; 95%CI: 1.22-4.69; P = 0.01).
  
  
  CONCLUSIONS
  Prophylactic abdominal drainage after pancreatic resection is still necessary, though more evidence from randomized controlled trials assessing prophylactic drainage after PD and distal pancreatectomy are needed.
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Chang-Wei
authors.initials: CW
authors.lastname: Dou
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Zhi-Kui
authors.initials: ZK
authors.lastname: Liu
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Jia
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Kang-Sheng
authors.initials: KS
authors.lastname: Tu
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Ying-Min
authors.initials: YM
authors.lastname: Yao
authors.affiliation: Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Qing-Guang
authors.initials: QG
authors.lastname: Liu
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Meta-analysis; Pancreatic resection; Prophylactic abdominal drainage; Systemic review