Italian survey about intraperitoneal drain use in distal pancreatectomy

Nicolò Pecorelli; Claudio Ricci; Alessandro Esposito; Giovanni Capretti; Stefano Partelli; Giovanni Butturini; Ugo Boggi; Alessandro Cucchetti; Alessandro Zerbi; Roberto Salvia; Massimo Falconi; Pan-Drain study group

doi:10.1007/s13304-024-01987-0

Italian survey about intraperitoneal drain use in distal pancreatectomy

Updates Surg. 2024 Oct 13. doi: 10.1007/s13304-024-01987-0. Online ahead of print.

Authors

Nicolò Pecorelli^{1

2}, Claudio Ricci³, Alessandro Esposito⁴, Giovanni Capretti^{5

6}, Stefano Partelli^{1

2}, Giovanni Butturini⁷, Ugo Boggi⁸, Alessandro Cucchetti^{9

10}, Alessandro Zerbi^{5

6}, Roberto Salvia⁴, Massimo Falconi^{1

2}; Pan-Drain study group

Collaborators

Pan-Drain study group:
Alberici Laura, Aleotti Francesca, Alfieri Sergio, Angrisani Marco, Anselmo Alessandro, Bannone Elisa, Barabino Matteo, Belfiori Giulio, Belli Andrea, Belli Giulio, Bonatti Chiara, Borgia Gianluca, Caccamo Lucio, Campra Donata, Caputo Damiano, Casadei Riccardo, Cescon Matteo, Citterio Davide, Colangelo Ettore, Colledan Michele, Coppola Roberto, Crippa Stefano, Dall'Olio Tommaso, De Carlis Luciano, De Giorgi Donato, De Luca Raffaele, Del Vecchio Antonella, Della Valle Raffaele, Di Benedetto Fabrizio, Di Dato Armando Di Domenico Stefano, Di Meo Giovanni, Di Sebastiano Pierluigi, Ettorre Giuseppe Maria, Fogliati Alessandro, Frena Antonio, Gavazzi Francesco, Giacomo Batignani, Gianotti Luca, Giuliante Felice, Grazi Gianluca, Grottola Tommaso, Gruttadauria Salvatore, Ingaldi Carlo, Isabella Frigerio, Izzo Francesco, La Barba Giuliano, Langella Serena, Lionetto Gabriella, Lombardi Raffaele, Maganuco Lorenzo, Maggino Laura, Malleo Giuseppe, Manzini Lorenzo, Marchegiani Giovanni, Marchetti Alessio, Marcucci Stefano, Massani Marco, Mastrangelo Laura, Mazzaferro Vincenzo, Mazzola Michele, Memeo Riccardo, Milanetto Anna Caterina, Mocchegiani Federico, Moraldi Luca, Moro Francesco, Napoli Niccolò, Nappo Gennnaro, Nardo Bruno, Pacilio Carlo Alberto, Paiella Salvatore, Papis Davide, Patriti Alberto, Patrono Damiano, Prosperi Enrico, Puglisi Silvana, Ramera Marco, Ravaioli Matteo, Rocca Aldo, Ruzzente Andrea, Sacco Luca, Scialantrone Grazisa, Serenari Matteo, Tamburrino Domenico, Tatani Bruna, Troisi Roberto, Veneroni Luigi, Vivarelli Marco, Zanello Matteo, Zanus Giacomo, Zingaretti Caterina Costanza, Zironda Andrea

Affiliations

¹ Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.
² Vita-Salute" San Raffaele University, Milan, Italy.
³ Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy. claudiochir@gmail.com.
⁴ General and Pancreatic Surgery Department, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
⁵ Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy.
⁶ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.
⁷ Surgical Department, HPB Unit Pederzoli Hospital, Peschiera Del Garda, Italy.
⁸ Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
⁹ Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
¹⁰ Morgagni E Pierantoni Hospital, Forlì, Italy.

PMID: 39397215
DOI: 10.1007/s13304-024-01987-0

Abstract

Intraperitoneal prophylactic drain (IPD) use in distal pancreatectomy (DP) is still controversial. A survey was carried out through the Italian community of pancreatic surgeons using institutional emails, Twitter, and Facebook accounts of the Italian Association for the Study of the Pancreas (AISP) and the Italian Association of Hepato-biliary-pancreatic Surgery (AICEP). The survey was structured to learn surgeons' practice in using IPD through questions and one clinical vignette. Respondents were asked to report their regrets for omission and commission regarding the IPD use for the clinical scenario, eliciting a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were built to identify respondents' attitudes. One hundred six surgeons completed the survey. Sixty-three (59.4%) respondents confirmed using at least 1 drain, while 43 (40.6%) placed 2 IPDs. Only 13 respondents (12.3%) declared a change in IPD strategy in patients at high risk of clinically relevant postoperative pancreatic fistula (CR-POPF), while 9 (9.4%) respondents changed their strategy in low-risk POPF situations. Thirty-five (35.5%) respondents declared they would remove the IPD within the third postoperative day (POD) in the absence of CR-POPF suspicion. The median omission regret, which proved to be the wrong decision, was 80 (50-100, IQR). The median regret due to the commission of IPD, which turned out to be useless, was 2.5 (1-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 7% (1-35, IQR). The threshold to perceive drain omission as the least regrettable choice was higher in female surgeons (P < 0.001), in surgeons who modulated the strategies based on the risk of CR-POPF, and in high volume centers (p = 0.039). The threshold was lower in surgeons who performed minimally invasive distal pancreatectomy (P < 0.001), adopted a closed system (P < 0.001), placed two IPDs (P < 0.001), or perceived the IPD as important to prevent reintervention (p = 0.047). Drain management after DP remains very heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients (7% of CR-POPF), leading to low regret in the case of the wrong decision, making it an acceptable clinical decision.

Keywords: Distal pancreatectomy; Drainage; Nicolò Pecorelli; Questionnaire; Regret; Survey.