Online citations, reference lists, and bibliographies.

Postoperative Pancreatic Fistula: We Need To Redefine Grades B And C.

Thilo Hackert, Ulf Hinz, Thomas Pausch, Irina Fesenbeck, Oliver Strobel, Lutz Schneider, Stefan Fritz, Markus W. Büchler
Published 2016 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
BACKGROUND Postoperative pancreatic fistula (POPF) is the most important complication after pancreatic surgery. In 2005, the International Study Group of Pancreatic Surgery (ISGPS) introduced a standardized POPF definition with severity grading from A to C. In recent years, interventional drainage (ID) has become the standard of care for symptomatic postoperative fluid collections or undrained POPF. From the original definition, it is unclear whether ID is categorized as POPF grade B or C. Therefore, international authors shift ID between grades B and C. The aim of the study was to analyze patients with ID (proposed new grade B) versus patients who underwent reoperation (grade C) for POPF. METHODS Between 2005 and 2013, all patients undergoing pancreatic resection were analyzed regarding POPF grade A-C. Demographic data, type of operation, postoperative complications, therapies and outcome were examined with focus on ID versus reoperation. RESULTS Of the 2,955 patients included, 403 developed POPF (13.6%). Among all POPF, 11% were grade A, 17% grade B (clinically symptomatic without ID), and 72% grade C. These patients underwent either ID (n = 165) or reoperation (n = 123). Patients with ID had an average hospital stay of 33 days and POPF-associated mortality of 0%. This was strikingly different from patients undergoing reoperation with a hospital stay of 47 days and POPF-associated mortality of 37% (P < .0001). CONCLUSION After 10 years of the ISGPS classification, there is a clear-cut outcome difference between patients undergoing POPF-associated ID or reoperation. We propose assigning all patients undergoing ID as POPF grade B. Patients undergoing reoperation should definitely remain within category C.
This paper references
Interventional radiology procedures after pancreatic resections for pancreatic and periampullary diseases.
Riccardo Casadei (2014)
Postoperative pancreatic fistula.
Thilo Hackert (2011)
Complications after pancreatic resection: diagnosis, prevention and management.
E. Lermite (2013)
Postoperative pancreatic fistula: an international study group (ISGPF) definition.
C. Bassi (2005)
Hospital Volume and Operative Mortality in the Modern Era
Bradley N. Reames (2013)
Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial.
Jianguo Qiu (2015)
Impact of Postoperative Pancreatic Fistula on Surgical Outcome—The Need for a Classification-driven Risk Management
Andreas Schmid Frymerman (2009)
A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients
Despoina Daskalaki (2010)
Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors.
D. Fuks (2009)
Options and Limitations in Applying the Fistula Classification by the International Study Group for Pancreatic Fistula
Florian Gebauer (2012)
Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition.
M. Wente (2007)
胃癌手術における手術部位感染発生率とInternational Study Group on Pancreatic Fistula分類による膵液瘻との関連性の検討
革島 洋志 (2014)
Pancreatic Anastomotic Leakage After Pancreaticoduodenectomy in 1,507 Patients: A Report from the Pancreatic Anastomotic Leak Study Group
K. Reid-Lombardo (2007)
Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution.
Brian K P Goh (2008)
Pancreatic fistula rate after pancreatic resection. The importance of definitions.
C. Bassi (2004)
Clinical Validation of the ISGPF Classification and the Risk Factors of Pancreatic Fistula Formation Following Duct-to-Mucosa Pancreaticojejunostomy by One Surgeon at a Single Center
Woo Seok Kim (2011)
Scoring System to Predict Pancreatic Fistula After Pancreaticoduodenectomy: A UK Multicenter Study.
Keith J Roberts (2015)
Pancreatic Fistula Rate after Pancreatic Resection
Claudio Bassi (2004)

This paper is referenced by
Pancreatic surgery: we need clear definitions
André L. Mihaljevic (2018)
Clinical Implications of the 2016 International Study Group on Pancreatic Surgery Definition and Grading of Postoperative Pancreatic Fistula on 775 Consecutive Pancreatic Resections
Alessandra Pulvirenti (2018)
Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery
Oliver Strobel (2017)
Chronic pancreatitis and resectable synchronous pancreatic carcinoma: A survival analysis.
Emrullah Birgin (2018)
Association Between Pancreatic Fistula and Long-term Survival in the Era of Neoadjuvant Chemotherapy.
Thomas Hank (2019)
A Predictive Risk Scoring System for Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy
Wuzheng Xia (2018)
Deliberate external pancreatic fistula after pancreaticoduodenectomy performed in the setting of acute pancreatitis, and its internalization through fistula-jejunostomy.
Sorin Tiberiu Alexandrescu (2019)
Comparison of Minimally Invasive versus Open Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Propensity Score Matching Analysis
Jaewoo Kwon (2020)
Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy
M Schindl (2018)
Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula
Tang Ee Ling Serene (2018)
Effect of early administration of coagulation factor XIII on fistula after pancreatic surgery: the FIPS randomized controlled trial
Yoshinori Takeda (2018)
Preoperative risk stratification for major complications following pancreaticoduodenectomy: Identification of high-risk patients.
Georg Wiltberger (2016)
Surgical Treatment of Pancreatic Fistula after Pancreatoduodenectomy
Yongsu Ma (2020)
Outpatient Drainmanagement of patients with clinically relevant Postoperative Pancreatic Fistula (POPF)
Sebastian Hempel (2017)
Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection.
Saxon J Connor (2016)
Postoperative pancreatic fistula: Microbial growth determines outcome☆
Martin Loos (2018)
Verschluss des Pankreasstumpfes bei Links- und Segmentresektion
Christoph W. Michalski (2016)
ESA-RANDOMIZED CONTROLLED TRIAL Teres Ligament Patch Reduces Relevant Morbidity After Distal R Randomized Controlled Trial) Pancreatectomy (the DISCOVE
Matthias Hassenpflug (2016)
Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis
Wentao Zhou (2019)
Surgical Resection for Pancreatic Cancer Using the International Study Group of Pancreatic Surgery (ISGPS) Classifications
Thilo Hackert (2016)
Identifying key outcome metrics in pancreatic surgery, and how to optimally achieve them.
Claudio Bassi (2017)
Do Drains Contribute to Pancreatic Fistulae? Analysis of over 5000 Pancreatectomy Patients
Rym El Khoury (2018)
Evaluation of P-POSSUM Risk Scoring System in Prediction of Morbidity and Mortality after Pancreaticoduodenectomy.
Raluca Bodea (2018)
Randomized clinical trial of pancreatojejunostomy with or without a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy: Matrix-bound sealant to prevent fistula after pancreatic resection
Martin Schindl (2018)
Grade B pancreatic fistulas do not affect survival after pancreatectomy for pancreatic cancer: A multicenter observational study.
Manabu Kawai (2016)
Early Fistulography Can Predict Whether Biochemical Leakage Develops to Clinically Relevant Postoperative Pancreatic Fistula
Yoshinori Takeda (2019)
A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy
Stefano Crippa (2020)
The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After
Claudio Bassi (2017)
Decoding Grade B Pancreatic Fistula sis and Subclassification Proposal A Clinical and Economical Analy
Laura Maggino (2019)
Komplikationsmanagement der Pankreasanastomose
Georg F. Weber (2017)
Facing the surgeon's nightmare: Incidence and Management of postoperative pancreatic fistulas grade C after pancreaticoduodenectomy based on the updated definition of the International Study Group (ISGPS).
Andreas Minh Luu (2020)
Modifications in the International Study Group for Pancreatic Surgery (ISGPS) definition of postoperative pancreatic fistula.
Alessandra Pulvirenti (2017)
See more
Semantic Scholar Logo Some data provided by SemanticScholar