International validation of the updated international study group of pancreatic surgery definition of postoperative pancreatic fistula after distal pancreatectomy

Abstract

Background: Postoperative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). The International Study Group of Pancreatic Surgery (ISGPS) recently updated their POPF definition. This study aimed to validate the updated definition in patients after DP. Methods: In this international retrospective cohort study, performed in 5 centers on patients after DP from 2005 to 2016, main focus was the effect of discarding grade A and the change of POPF grade B by comparing the distribution of complications amongst POPF grades according to the old (2005) and updated (2016) definitions. Results: In total, 1089 patients were included. The incidence of POPF grade B/C decreased with the updated definition (355(33%) vs 260(24%) <0.01), mostly because of less POPF grade B (328(30%) vs 234(21%) <0.01). The rate of POPF grade C was comparable for the old and updated definition (27(2%) vs 26(2%) >0.99). The old no POPF group was comparable regarding distribution of complications with the updated no POPF group (including biochemical leak) (Clavien-Dindo ≥3 29(5%) vs 46(6%) = 0.32, ICU 15(3%) vs 20(2%) = 0.6 and hospital stay 7(6–9) vs 7(6–9) = 0.30). In patients with a POPF grade B according to the updated definition more Clavien-Dindo ≥3 complications (124(38%) vs 119(51%) <0.01) and longer hospital stay (9(9–13) vs 9(7–15) <0.01) were seen. The rate of ICU admissions amongst POPF grade B patients was comparable (10(3%) vs 9(4%) = 0.25). The decrease in POPF grade B/C with the updated definition was similar in minimally invasive (149 (42%) vs 101(39%)) and open DP (206(58%) vs 159(61%)) (=0.05). Conclusion: The updated 2016 ISGPS POPF definition showed an improvement in the ability to discriminate between patients with and without a (clinically relevant) POPF after DP. This improvement was present in both minimally invasive and open DP.