Modification of a new subclassification of Grade B postoperative pancreatic fistula: A bicenter retrospective cohort study

Abstract

is still the definitive operation to treat tumors in the pancreatic head and peri-ampullary region. Despite the decreased mortality of PD in high-volume institutions, the rate of postoperative complications remains high. [1][2][3][4][5] Postoperative pancreatic fistula (POPF) is the most common complication and the prevalence is 5%-30%. 6,7 POPF may cause serious severe secondary complications, such as post-pancreatectomy hemorrhage (PPH), intra-abdominal infection, and even death, which may lead to prolonged length of hospital stay and increased hospital costs.The International Study Group for Pancreatic Fistula (ISGPF) standardized the definition and classification of POPFs in 2005. 8 By reviewing studies for more than 10 years,

Conservative drain management increases the incidence of grade B postoperative pancreatic fistula without increasing serious complications: Does persistent drainage reflect the quality of pancreatic surgery or institutional policy?

“…Studies to date, including the current study, reveal a wide range for the rate of persistent drain use for > 21 days among patients with grade B POPF (4%-61%), demonstrating that the current ISGPF grading system might reflect institutional practices rather than the quality of pancreatic surgery. [9][10][11] Moreover, the comparison based on ISGPF grading system and Clavien-Dindo grading system between institutions that adopted conservative drain management and those adopted non-conservative drain management supported our speculation. The former institutions reported lower incidence rates for overall and POPF-related major morbidities (Clavien-Dindo grade ≥ 3) compared with the latter institutions, although the incidence rates of CR-POPF were two to three times higher in the former institutions than in the latter institutions (Table 5).…”

“…In addition, our findings raise concerns regarding the use of current ISGPF grading system to compare the quality of pancreatic surgery among institutions that adopt different drain management protocols for POPF. Studies to date, including the current study, reveal a wide range for the rate of persistent drain use for > 21 days among patients with grade B POPF (4%–61%), demonstrating that the current ISGPF grading system might reflect institutional practices rather than the quality of pancreatic surgery 9‐11 . Moreover, the comparison based on ISGPF grading system and Clavien‐Dindo grading system between institutions that adopted conservative drain management and those adopted non‐conservative drain management supported our speculation.…”

“…8 However, in the current ISGPF grading system, grade B POPF is a clinically heterogeneous condition because of its treatment-based definition. 7,9,10 A recent study from Maggino et al reported that the clinical burden of patients with grade B POPF requiring only persistent drainage over 21 days (B-drain) was distinctly lower than that of patients with grade B POPF requiring pharmacologic management or interventional procedures. 9 Moreover, van Hilst et al reported that the clinical course was comparable between patients requiring only persistent drainage over 21 days and those with biochemical leakage (BL).…”

<p>Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy</p>

“…In China, parenteral nutrition (PN) was still the most common route of postoperative nutrition support, and artificial nutrition was provided to all patients on postoperative day 2, often beginning with PN. 19 PN is defined as intravenous administration of a combination of amino acids, glucose, and fat meeting the recommendation of guidelines. 20 The transition from PN to enteral nutrition through tube feeding or oral nutrition supplement depended on the patients' condition.…”

Preoperative Anemia Is A Predictor of Cacoethic Postoperative Outcomes Following Open Pancreatoduodenectomy – A Propensity Score-Based Analysis

“…Pancreatoduodenectomy is one of the major abdominal operations associating with high postoperative mortality and morbidity. There are many risk factors throughout the whole perioperative procedure [7].…”