Clinical Implications of the 2016 International Study Group on Pancreatic Surgery Definition and Grading of Postoperative Pancreatic Fistula on 775 Consecutive Pancreatic Resections

Pulvirenti, Alessandra; Marchegiani, Giovanni; Pea, Antonio; Allegrini, Valentina; Esposito, Alessandro; Casetti, Luca; Landoni, Luca; Malleo, Giuseppe; Salvia, Roberto; Bassi, Claudio

doi:10.1097/sla.0000000000002362

Cited by 86 publications

(82 citation statements)

References 22 publications

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“…The outcome measures of the present trial were adapted retrospectively according to the new definition of POPF, but the incidence of biochemical leakage was kept in the report in order to provide a complete picture of the tightening capacity of fibrin sealant patches. The proportion of patients with biochemical leakage was significantly higher here than reported previously, whereas the incidence of grade B and C POPF was not. The authors are not able to provide a conclusive explanation for this as the participating centres have a high annual caseload of pancreatic resections, with pancreatojejunostomy performed according to general standards, with little variation.…”

Section: Discussioncontrasting

confidence: 87%

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Schindl

Függer

Götzinger

et al. 2018

British Journal of Surgery

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BackgroundThe potential for a fibrin sealant patch to reduce the risk of postoperative pancreatic fistula (POPF) remains uncertain. The aim of this study was to evaluate whether a fibrin sealant patch is able to reduce POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy.MethodsIn this multicentre trial, patients undergoing pancreatoduodenectomy were randomized to receive either a fibrin patch (patch group) or no patch (control group), and stratified by gland texture, pancreatic duct size and neoadjuvant treatment. The primary endpoint was POPF. Secondary endpoints included complications, drain‐related factors and duration of hospital stay. Risk factors for POPF were identified by logistic regression analysis.ResultsA total of 142 patients were enrolled. Forty‐five of 71 patients (63 per cent) in the patch group and 40 of 71 (56 per cent) in the control group developed biochemical leakage or POPF (P = 0·392). Fistulas were classified as grade B or C in 16 (23 per cent) and ten (14 per cent) patients respectively (P = 0·277). There were no differences in postoperative complications (54 patients in patch group and 50 in control group; P = 0·839), drain amylase concentration (P = 0·494), time until drain removal (mean(s.d.) 11·6(1·0) versus 13·3(1·3) days; P = 0·613), fistula closure (17·6(2·2) versus 16·5(2·1) days; P = 0·740) and duration of hospital stay (22·1(2·2) versus 18·2(0·9) days; P = 0·810) between the two groups. Multivariable logistic regression analysis confirmed that obesity (odds ratio (OR) 5·28, 95 per cent c.i. 1·20 to 23·18; P = 0·027), soft gland texture (OR 9·86, 3·41 to 28·54; P < 0·001) and a small duct (OR 5·50, 1·84 to 16·44; P = 0·002) were significant risk factors for POPF. A patch did not reduce the incidence of POPF in patients at higher risk.ConclusionThe use of a fibrin sealant patch did not reduce the occurrence of POPF and complications after pancreatoduodenectomy with pancreatojejunostomy. Registration number: 2013‐000639‐29 (EudraCT register).

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Section: Discussioncontrasting

confidence: 87%

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Schindl

Függer

Götzinger

et al. 2018

British Journal of Surgery

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“…Age correlated with a higher risk of postoperative morbidity, whereas it was associated with better physical status in the analysis of QoL in the longer term. Morbidity (59·3 per cent) and 90‐day mortality (3·3 per cent) rates were comparable to the rates of 32–69 and 0–5 per cent respectively reported in other large studies of postoperative outcomes after pancreatoduodenectomy. As reported previously, the present study identified older age and long operating time as independent risk factors for major postoperative complications, whereas no specific risk factor for death could be identified.…”

Section: Discussionsupporting

confidence: 80%

“…Because postoperative outcomes after total pancreatectomy and pancreatoduodenectomy are almost comparable, the primary concern in extending resection to the entire pancreas is therefore related to the inevitable long‐term morbidity associated with the apancreatic state. Total pancreatectomy is characterized by complete loss of exocrine and endocrine pancreatic functions, and therefore by intestinal malabsorption and a diabetic state defined as ‘brittle’, owing to the challenging management of blood glucose levels.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes and long-term quality of life after total pancreatectomy

Pulvirenti

Pea

Rezaee

et al. 2019

British Journal of Surgery

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Background Total pancreatectomy is required to treat diseases involving the entire pancreas, and is characterized by high morbidity rates and impaired long‐term quality of life (QoL). To date, risk factors associated with perioperative and long‐term outcomes have not been determined fully. Methods Data from patients undergoing total pancreatectomy between 2000 and 2014 at two high‐volume centres were analysed retrospectively to assess risk factors for major surgical complications. Short Form (SF) 36, European Organisation for Research and Treatment of Cancer QLQ‐PAN26 and Audit of Diabetes Dependent questionnaires, as well as an original survey were used to investigate factors influencing QoL. Results A total of 329 consecutive patients underwent total pancreatectomy in the two centres. Overall, total pancreatectomy was associated with a morbidity rate of 59·3 per cent and a 30‐day mortality rate of 2·1 per cent. Age over 65 years and long duration of surgery (more than 420 min) were independently associated with major complications (at least Clavien–Dindo grade III). QoL analysis was available for 94 patients (28·6 per cent) with a median follow‐up of 63 (i.q.r. 20–109) months; the most common indication for total pancreatectomy in these patients was intraductal papillary mucinous neoplasms (46 per cent). Both physical (PCS) and mental (MCS) component summary scores of SF‐36® were lower after total pancreatectomy compared with scores for a normative population (P = 0·020 and P < 0·001 respectively). Linear regression analysis showed that young age, abdominal pain and worse perception of body image were negatively associated with the PCS, whereas diabetes, sexual satisfaction and perception of body image affected MCS. Conclusion Total pancreatectomy can be performed with acceptable morbidity and mortality rates. Older patients had a higher risk of postoperative complications but reported better QoL than younger patients.

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“…This variation in clinical severity led to the International Study Group on Pancreatic Fistula (ISGPF) to develop a standardized grading system for pancreatic fistulae, which subcategorizes the fistula into either Grade A, B, or C. Grade A fistulae are essentially subclinical and were recently reclassified as biochemical leaks, while grades B and C fistulae have significant downstream effects and together can be considered clinically‐relevant postoperative pancreatic fistula (CR‐POPF) . These definitions have been validated and are well accepted in clinical practice …”

Section: Introductionmentioning

confidence: 99%

“…5,6 These definitions have been validated and are well accepted in clinical practice. [7][8][9] Significant efforts have been aimed at identifying risk factors that predict CR-POPF formation. The most well-validated predictive model is the fistula risk score (FRS), which uses pancreatic duct diameter, gland texture, intraoperative blood loss, and pathology to stratify patient risk.…”

mentioning

confidence: 99%

Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

Ellis

Hewitt

Liu

et al. 2019

Journal of Surgical Oncology

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Background Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically‐relevant postoperative pancreatic fistula (CR‐POPF) that are routinely available in the preoperative setting. Methods Preoperatively available variables for all pancreaticoduodenectomies from 2014‐2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and internal validation subgroups. Results Among 15 033 pancreaticoduodenectomies, the CR‐POPF rate was 16.7%. CR‐POPF was more likely in patients that were male (odds ratio [OR], 1.51), obese (body mass index [BMI] > 30, OR, 1.97), had minimal preoperative weight loss (OR, 1.25), had a nondilated pancreatic duct (OR, 1.81), did not have diabetes, (OR, 1.80), did not receive neoadjuvant therapy (OR, 1.78), had no evidence of biliary obstruction (OR, 1.18), or had nonadenocarcinoma pathology (OR, 1.96; all P < 0.01). Patients with three or fewer risk factors had a CR‐POPF rate of 7.1%, while those with six or more risk factors had a CR‐POPF rate of 26.3% (P < 0.001). Conclusion Preoperative CR‐POPF risk evaluation could be a useful tool in patient counseling and surgical planning, and risk may allow for more well‐informed decisions regarding perioperative management, including enhanced recovery protocols and use of somatostatin analogs.

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Clinical Implications of the 2016 International Study Group on Pancreatic Surgery Definition and Grading of Postoperative Pancreatic Fistula on 775 Consecutive Pancreatic Resections

Cited by 86 publications

References 22 publications

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Perioperative outcomes and long-term quality of life after total pancreatectomy

Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

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