Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
Pancreatology. 2019 Apr;19(3):449-455. doi: 10.1016/j.pan.2019.03.004. Epub 2019 Mar 14.
The ISGPS classification of post-operative pancreatic fistula (POPF) was recently revised, introducing the concept of biochemical leak (BL) which replaced grade A POPF. More recently, an additional distinction on three different subclasses for grade B (B1-B3) POPF was proposed. The aim of this study was to evaluate the impact of these modifications in clinical practice.
All pancreatico-duodenectomies (PD) and distal pancreatectomies (DP) performed between 2010 and 2016 were retrospectively evaluated. Incidence and grade of POPF using the old and new ISGPS classification were evaluated. Three grade B subclasses (B1: maintenance of abdominal drain >3 weeks; B2: adoption of specific medical treatments for POPF; B3: use of radiological procedures) were evaluated for clinical severity.
A total of 716 patients (502 PD, 214 DP) were evaluated. The new ISGPS classification reduced the reported rate of POPF (30.7% vs 35.2% for PD, p > 0.05; 28% vs 44.9% for DP, p < 0.05), due to the abolition of grade A POPF. Grade B1, B2 and B3 rates were 3.1%, 73.8% and 23.1% in PD and 12.3%, 47.4% and 40.3% in DP, respectively. Passing from B1 to B3, significant increases in wound infection (0-40%), mean length of stay in PD (14.7-22.5 days; p < 0.05) and readmission rate in DP (0-39.1%) were observed.
The new ISGPS classification significantly reduces the reported rate of POPF, particularly after DP. The three different grade B subclasses (B1-B3) better discriminate the severity of post-operative course, especially after PD.
国际胰腺外科学会（ISGPS）对术后胰瘘（POPF）的分类最近进行了修订，引入了生化漏（BL）的概念，取代了 A 级 POPF。最近，还提出了 B 级（B1-B3）POPF 的三个不同亚类的进一步区分。本研究旨在评估这些修改在临床实践中的影响。
回顾性评估了 2010 年至 2016 年间进行的胰十二指肠切除术（PD）和胰体尾切除术（DP）。使用旧和新 ISGPS 分类评估 POPF 的发生率和分级。评估了三个 B 级亚类（B1：维持引流管>3 周；B2：采用特定的 POPF 治疗方法；B3：使用放射学程序）的临床严重程度。
共评估了 716 例患者（502 例 PD，214 例 DP）。新的 ISGPS 分类降低了报告的 POPF 发生率（PD 为 30.7%比 35.2%，p>0.05；DP 为 28%比 44.9%，p<0.05），原因是 A 级 POPF 的废除。PD 中 B1、B2 和 B3 的发生率分别为 3.1%、73.8%和 23.1%，DP 中分别为 12.3%、47.4%和 40.3%。从 B1 到 B3，PD 中的伤口感染率（0-40%）、平均住院时间（14.7-22.5 天；p<0.05）和 DP 中的再入院率（0-39.1%）显著增加。
新的 ISGPS 分类显著降低了报告的 POPF 发生率，特别是在 DP 之后。三个不同的 B 级亚类（B1-B3）更好地区分了术后病程的严重程度，特别是在 PD 之后。
