{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:49:17Z","timestamp":1788914957325,"version":"build-2803163510"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":45,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NextGenerationEU and STARS@UNIPD","award":["MARC_STARS_MUR24_01"],"award-info":[{"award-number":["MARC_STARS_MUR24_01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The ability of drain fluid amylase (DFA) to predict pancreatic fistula (POPF) and safely guide early drain removal is unknown in high-risk pancreatoduodenectomy (HR-PD). The aim of this analysis was to develop a new risk-based algorithm for drain management after pancreatoduodenectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All consecutive patients undergoing pancreatoduodenectomy (2019\u20132024) at two institutions were included. During surgery, patients were stratified into HR-PD, defined according to the International Study Group on Pancreatic Surgery score (soft gland and duct \u2264 3\u2005mm), and non-HR-PD. Postoperative predictors (DFA, serum amylase\/lipase, C-reactive protein) were retrieved on postoperative days (PODs) 1 to 5 and correlated to POPF development using a risk-based approach. Results were validated in a retrospective cohort (2015\u20132019) of pancreatoduodenectomies performed at the same institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 825 screened patients, 788 were included. HR-PD (251, 32%) had higher POPF rates (50% versus 9%; P &amp;lt; 0.001) and worse outcomes. In HR-PD, DFA had a lower area under the curve for POPF for POD 1 (0.73 versus 0.85; P = 0.003) and POD 3 (0.74 versus 0.88; P = 0.002) compared with non-HR-PD, but similar for POD 5 (0.83 versus 0.86; P = 0.535), whereas serum amylase\/lipase maintained a low area under the curve for POPF compared with non-HR-PD. The optimal criteria for POD 3 drain removal in non-HR-PD were POD 1 DFA &amp;lt; 200\u2005UI\/l, POD 3 DFA &amp;lt; 150\u2005UI\/l, and absence of elevated serum amylase\/lipase on POD 1 (Youden\u2019s index 0.674). In HR-PD, the criteria for POD 5 drain removal were POD 5 DFA &amp;lt; 150\u2005UI\/l and POD 5 C-reactive protein &amp;lt; 150\u2005mg\/ml (Youden\u2019s index 0.593).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with an intrinsic higher risk of POPF, early predictors are less reliable, and drain management protocols should be tailored. In non-HR-PD, an early removal policy can be recommended based on DFA and serum amylase\/lipase. In HR-PD, drain removal may be safely deferred until POD 5 according to DFA and C-reactive protein.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag068","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T11:35:36Z","timestamp":1777116936000},"source":"Crossref","is-referenced-by-count":2,"title":["Drain management after pancreatoduodenectomy: risk-stratified dynamic algorithm"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2072-7114","authenticated-orcid":false,"given":"Giampaolo","family":"Perri","sequence":"first","affiliation":[{"name":"Hepato-pancreato-biliary and Liver Transplant Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua , Padua 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