Details

Autor(en) / Beteiligte

• Schuh, Fabian
• Mihaljevic, André L
• Probst, Pascal
• Trudeau, Maxwell T
• Müller, Philip C
• Marchegiani, Giovanni
• Besselink, Marc G
• Uzunoglu, Faik
• Izbicki, Jakob R
• Falconi, Massimo
• Castillo, Carlos Fernandez-Del
• Adham, Mustapha
• Z'graggen, Kaspar
• Friess, Helmut
• Werner, Jens
• Weitz, Jürgen
• Strobel, Oliver
• Hackert, Thilo
• Radenkovic, Dejan
• Kelemen, Dezso
• Wolfgang, Christopher
• Miao, Y I
• Shrikhande, Shailesh V
• Lillemoe, Keith D
• Dervenis, Christos
• Bassi, Claudio
• Neoptolemos, John P
• Diener, Markus K
• Vollmer, Jr, Charles M
• Büchler, Markus W

Titel

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula: A classification of the International Study Group of Pancreatic Surgery

Ist Teil von

• Annals of surgery, 2023-03, Vol.277 (3), p.e597-e608

Ort / Verlag

United States

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD). Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking. A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort. Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62-5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively ( P < 0.001). For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results.