Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy

Abstract Background The current definition for postoperative pancreatic fistula (POPF) is based on the drain fluid amylase (DFA), and drains must be positioned adequately. We investigated the impact of DFA level, drain position and fluid collection after distal pancreatectomy (DP). Methods We performed a retrospective study of 516 patients who underwent DP between June 2004 and December 2018. Patients were excluded if DP was not main procedure, DFA was not measured, postoperative computed tomography (CT) was not performed, or drains were removed before CT. Demographic and perioperative data were analyzed in 422 eligible patients. Results Of 422 patients, 49(11.6%) had clinically relevant (CR)‐POPF and 102(24.2%) had a malpositioned drain. There was no difference in CR‐POPF rate between the high and low DFA groups (12.6% vs 10.7%, P = 0.649). Drain malposition was more frequently associated with symptomatic fluid collection and CR‐POPF than well‐positioned drains. Male sex, high body mass index, transfusion, and drain malposition were CR‐POPF risk factors. In subgroup analysis, drain malposition was also an independent risk factor for CR‐POPF in the low DFA group. Conclusions After DP, the incidence of CR‐POPF in the high and low DFA groups was similar and drain malposition increased the risk of CR‐POPF. Thus, the ISGPS definition of POPF based on DFA levels is limited in DP, and DFA levels should be interpreted together with the drain position.