Hackert Thilo, Hinz Ulf, Pausch Thomas, Fesenbeck Irina, Strobel Oliver, Schneider Lutz, Fritz Stefan, Büchler Markus W
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Surgery. 2016 Mar;159(3):872-7. doi: 10.1016/j.surg.2015.09.014. Epub 2015 Oct 23.
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.
术后胰瘘（POPF）是胰腺手术后最重要的并发症。2005年，国际胰腺手术研究组（ISGPS）引入了标准化的POPF定义，严重程度分为A至C级。近年来，介入引流（ID）已成为有症状的术后液体积聚或未引流的POPF的标准治疗方法。从最初的定义来看，ID应归类为POPF B级还是C级尚不清楚。因此，国际上的作者在B级和C级之间对ID进行了调整。本研究的目的是分析接受介入引流（拟为新的B级）的患者与因POPF接受再次手术（C级）的患者。
2005年至2013年期间，对所有接受胰腺切除术的患者进行了POPF A - C级分析。检查了人口统计学数据、手术类型、术后并发症、治疗方法和结果，重点关注介入引流与再次手术的情况。
在纳入的2955例患者中，403例发生了POPF（13.6%）。在所有POPF患者中，11%为A级，17%为B级（临床有症状但未行介入引流），72%为C级。这些患者要么接受了介入引流（n = 165），要么接受了再次手术（n = 123）。接受介入引流的患者平均住院时间为33天，与POPF相关的死亡率为0%。这与接受再次手术的患者明显不同，再次手术患者的住院时间为47天，与POPF相关的死亡率为37%（P <.0001）。
在ISGPS分类实施10年后，接受与POPF相关的介入引流或再次手术的患者之间存在明显的结局差异。我们建议将所有接受介入引流的患者归为POPF B级。接受再次手术的患者肯定应保留在C级。
