Pancreas Surgery Unit, Pancreas Institute, Verona University Hospital, Verona, Italy.
Ann Surg. 2018 Dec;268(6):1069-1075. doi: 10.1097/SLA.0000000000002362.
The aim of the present study was to evaluate the clinical implications of the 2016 International Study Group for Pancreatic Surgery (ISGPS) definition and classification of postoperative pancreatic fistula (POPF) using a single high-volume institutional cohort of patients undergone pancreatic surgery.
The ISGPS definition and grading system of POPF has been recently updated. Although the rationale for the changes was supported by previous studies, the effect of the new definition and classification scheme on surgical series has not been established.
A total of 775 patients undergone pancreatic surgery in our institute from 2013 to 2015 were reviewed. The parameters modified in the ISGPS classification were analyzed according to postoperative outcomes. Finally the classification was validated by external clinical and economical outcomes.
Applying the 2016 scheme, 17.5% of patients changed classification group compared to the 2015 system. Grade B increased from 11.5% to 22.1%, whereas grade C decreased from 15.2% to 4.6%. Biochemical leak occurred in 7% of patients, and it did not differ from the non-POPF condition in terms of surgical outcomes. Non-POPF group, grades B and C POPF differed significantly in terms of intensive care unit staying (P < 0.001), length of stay (P < 0.001), readmission rate (P < 0.001), and hospital costs (P < 0.001).
The present study has confirmed the pertinence of the changes introduced in the 2016 ISGPS POPF definition and grading. This updated classification is effective in identifying three conditions that differ in terms of clinical and economic outcomes. These results suggested the reliability of the new definition and scheme in classifying POPF-related outcomes.
本研究旨在使用单一高容量机构队列的胰腺手术患者，评估 2016 年国际胰腺外科研究组（ISGPS）术后胰腺瘘（POPF）定义和分类的临床意义。
ISGPS 的 POPF 定义和分级系统最近已更新。尽管先前的研究支持了这些变化的原理，但新定义和分类方案对手术系列的影响尚未确定。
对我院 2013 年至 2015 年间行胰腺手术的 775 例患者进行回顾性分析。根据术后结果分析 ISGPS 分类中修改的参数。最后通过外部临床和经济结果验证分类。
应用 2016 年方案，与 2015 年系统相比，17.5%的患者分类组发生变化。B 级从 11.5%增加到 22.1%，而 C 级从 15.2%下降到 4.6%。生化漏发生在 7%的患者中，与非 POPF 状态在手术结果方面没有差异。非 POPF 组、B 级和 C 级 POPF 在重症监护病房停留时间（P < 0.001）、住院时间（P < 0.001）、再入院率（P < 0.001）和住院费用（P < 0.001）方面存在显著差异。
本研究证实了 2016 年 ISGPS POPF 定义和分级中引入的变化的相关性。这种更新的分类有效地确定了三种在临床和经济结果方面不同的情况。这些结果表明，新定义和方案在分类 POPF 相关结果方面具有可靠性。
