Development of Novel Criteria for Drain Removal After Pancreaticogastrostomy in Pancreaticoduodenectomy: A Retrospective Analysis and Validation Study at a Single Institution

Purpose Postoperative pancreatic fistula (POPF) remains a major complication following pancreaticoduodenectomy (PD). Although pancreaticogastrostomy (PG) reduces POPF risk, the optimal criteria for drain management in PG cases remain unclear. Methods This single-institution retrospective study analyzed 195 consecutive PD cases involving a soft pancreas and PG. New criteria for safe drain removal were developed based on independent risk factors identified through a multivariate analysis. A prospective validation study was then conducted in 70 consecutive soft pancreas cases to assess the safety and efficacy of these criteria. Results In the retrospective cohort, white blood cell count (WBC) > 8200/µL, drain fluid amylase (DFA) > 160 U/L on postoperative day (POD) 5, and delayed nasogastric (NG) tube removal were identified as independent risk factors. The criteria for drain removal were defined as: WBC ≤ 8200/µL, DFA ≤ 160 U/L, and NG tube removal by POD5. In the validation cohort, 42 out of 70 patients met the criteria; none developed Clavien–Dindo grade IIIa or higher complications after drain removal. The incidence of delayed gastric emptying (DGE) was significantly lower ( p  < 0.01). Conclusion In patients undergoing PG with a soft pancreas, application of the new criteria enables safe early drain removal and may help reduce the incidence of DGE.