Definition Of Postoperative Pancreatic Fistula Research Articles

Use and acceptance of the International Study Group for Pancreatic Fistula (ISGPF) definition and criteria in the surgical literature

BackgroundThe level of utilization and acceptance of the 2005 International Study Group for Pancreatic Fistula (ISGPF) definition for postoperative pancreatic fistula (POPF) has not be quantified. The aim of this study was to determine the uptake of the ISGPF definition and evaluate its use in the surgical literature. MethodsA sample of primary studies, review articles, and textbooks were identified through screening of literature searches. Included citations were assessed for their definition of POPF and use of the ISGPF criteria. ResultsFrom 2006 to 2009, 6%–63% of primary papers were compliant with the ISGPF definition compared to 84%–98% from 2010 onwards. Of the primary studies compliant with the ISGPF criteria, 36% focused on grade B and C fistula and 15% did not report grade A fistula. 88% of European papers used the criteria compared to 77% and 72% of Asian and North American papers, respectively (p = 0.033). 46% of review articles and textbooks did not define POPF. Among those that defined POPF, 74% cited the ISGPF definition exclusively while 26% mentioned other definitions. ConclusionThe ISGPF criteria have been widely adopted and accepted as the standard for defining POPF, although the utility of grade A fistulas is questionable.

Use and acceptance of the international study group for pancreatic fistula (ISGPF) criteria in surgical literature

Objective: The International Study Group for Pancreatic Fistula (ISGPF) developed a definition for postoperative pancreatic fistula (POPF) in 2005. The aim of this study was to determine the acceptance of the ISGPF definition and evaluate its use in surgical literature. Methods: Two literature searches were performed to identify primary papers as well as review papers and textbooks published from 2006 to 2015. Papers were screened for inclusion via a two-stage screening process. Included primary papers were assessed for their definition of POPF and use of the ISGPF criteria, while review papers and textbooks were graded on a 4-point scale based on their definition of POPF: 0 – not defined, 1 – non-ISGPF definitions, 2 – ISGPF along with other definitions, 3 – only ISGPF. Results: 264 primary papers and 90 reviews/textbooks were included. From 2006 to 2015, there was a significant increase in use of the ISGPF criteria in primary papers (p < 0.001) (Figure 1). Among studies that used the ISGPF criteria, 36% reported grades B and C separately and 14% reported only B and C. 88% of European papers used the criteria compared to 77% and 72% of Asian and North American papers, respectively (p = 0.033). 46% of reviews/textbooks did not define POPF. Among those that defined POPF, 74% cited the ISGPF definition while 22% used ISGPF along with other definitions. Conclusion: The ISGPF criteria are widely used and accepted as the standard for defining POPF. Many authors emphasize clinically relevant grades in their reporting while some omit grade A altogether, placing the importance and utility of grade A fistulas in question.

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality.

Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, model-building strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42%), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71%) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86%) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula.

Postoperative pancreatic fistula: We need to redefine grades B and C

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. 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. 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). 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.

Management of postoperative pancreatic fistula

The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication varies between 3 % after pancreatic head resection and up to 35 % following distal pancreatectomy. In 2005, the international definition of postoperative pancreatic fistula was standardized according to the approach of the International Study Group of Pancreatic Surgery (ISGPS) including an A-C grading system of the severity. Consequently, results from different studies have become comparable and the historically reported fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, fistula-associated complications and management of postoperative pancreatic fistula.

Preliminary results of binding pancreaticojejunostomy.

Backgrounds/AimsThe post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng.MethodsWe retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines.ResultsOf the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management.ConclusionsThe BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.

Randomized, placebo-controlled study of the efficacy of preoperative somatostatin administration in the prevention of postoperative complications following pancreaticoduodenectomy.

This randomized, placebo-controlled trial was analyzed in order to compare different methods of somatostatin administration in postoperative pancreatic fistula (POPF) and other postoperative complications following pancreaticoduodenectomy (PD). Patients were randomized to a control group (n=32) and an experimental group (n=35). The primary endpoint was the incidences of POPF and other postoperative complications. The definition of POPF was classified as described by the International Study Group of Pancreatic Surgery. In the experimental group, the initial somatostatin was infused 1 day before operation and continued for 7 days after surgery. The incidences of POPF did not show a significant difference between the 2 groups (11/30, 36.7% vs. 14/30, 46.7%; p>0.385). However, blood transfusion volume was 1.7±1.53U in the experimental group and 2.7±2.2U in the control group (p=0.034). Furthermore, the abdominal amylase concentration was significantly lower in the experimental group (p=0.038 and p=0.043, respectively) in both Postoperative Day (POD) 3 and POD 7. Preoperative prophylactic use of somatostatin cannot decrease the incidence of POPF and other complications after PD compared to postoperative use. However, the amylase concentration of the abdominal drainage and the blood transfusion volume seems to be decreased. Further experimental investigations are needed to estimate the value of preoperative use of somatostatin and clear the concrete mechanism.

Postoperative pancreatic fistula: An international study group (ISGPF) definition

Postoperative pancreatic fistula (POPF) is still regarded as a major complication. The incidence of POPF varies greatly in different reports, depending on the definition applied at each surgical center. Our aim was to agree upon an objective and internationally accepted definition to allow comparison of different surgical experiences. An international panel of pancreatic surgeons, working in well-known, high-volume centers, reviewed the literature on the topic and worked together to develop a simple, objective, reliable, and easy-to-apply definition of POPF, graded primarily on clinical impact. A POPF represents a failure of healing/sealing of a pancreatic-enteric anastomosis or a parenchymal leak not directly related to an anastomosis. An all-inclusive definition is a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity. Three different grades of POPF (grades A, B, C) are defined according to the clinical impact on the patient's hospital course. The present definition and clinical grading of POPF should allow realistic comparisons of surgical experiences in the future when new techniques, new operations, or new pharmacologic agents that may impact surgical treatment of pancreatic disorders are addressed.