It had remained still controversial whether routine intraperitoneal drains decrease the postoperative complications after pancreatectomy. In 2014, a multicenter randomized controlled trial in the USA has evaluated whether pancreaticoduodenectomy without routine intraperitoneal drains does not increase the incidence of severe postoperative complications [16]. One hundred thirty-seven patients who underwent pancreaticoduodenectomy were enrolled in this study; 68 patients were randomized to drain group, and 69 patients were randomized to no drain group. The primary endpoint for this a multicenter randomized controlled trial was the 60-day grade II or greater complication rate. This study has demonstrated that pancreaticoduodenectomy without intraperitoneal drainage was associated with increased 60-day grade II or greater complication rate, which was the primary endpoint for this a multicenter randomized controlled trial (drain group 52% vs. no drain group 68%, P = 0.047). Moreover, no drain in this study significantly increased gastroparesis (drain group 24% vs. no drain group 42%, P = 0.021), intra-abdominal abscess (drain group 12% vs. no drain group 26%, P = 0.033), diarrhea more than grade II (drain group 3% vs. no drain group 17%, P = 0.005), abdominal fluid collection (drain group 2% vs. no drain group 12%, P = 0.033). The most important point was that the study was stopped early by the Data Safety Monitoring Board although this study were planned to require a total of 752 patients for the two groups at first. Because mortality in no drain group was 12% which was a fourfold increase compared to 3% in drain group after 90-day follow-up. This study concluded that pancreaticoduodenectomy without intraperitoneal drainage significantly increased the incidence of severe complications and contributed to increased mortality.