Drain fluid amylase and CRP on day 3 may guide earlier drain removal after distal pancreatectomy

The edition in brief

A single-centre trial of 104 patients having laparoscopic colorectal cancer surgery found that esketamine 0.2 mg/kg before the end of surgery brought first flatus forward from 60 to 52 hours, without a change in length of stay or costs. A meta-analysis of 13 studies found telemedicine follow-up after colorectal surgery made little difference to 30-day readmission (OR 0.96, 95% CI 0.69 to 1.35) or emergency visits (OR 1.02, 0.67 to 1.57), with low-certainty evidence, though satisfaction was higher. In a retrospective single-centre cohort of 94 patients with symptomatic collections after distal pancreatectomy, endoscopic drainage was linked to a shorter total hospital stay than radiologic drainage (19 vs 31 days), with a risk of bleeding after lumen-apposing stents. A retrospective study of 258 distal pancreatectomies found drain fluid amylase of 1,000 U/L or more on day 3 (OR 8.21) and CRP of 12 mg/dL or more on day 3 (OR 3.37) independently predicted clinically relevant pancreatic fistula.