Bannone Elisa, Cattelani Alice, Corvino Gaetano, Marchetti Alessio, Andreasi Valentina, Fermi Francesca, Partelli Stefano, Pecorelli Nicolò, Tamburrino Domenico, Esposito Alessandro, Malleo Giuseppe, Bhandare Manish, Gundavda Kaival, Jiang Kuirong, Lu Zipeng, Yin Jie, Lavu Harish, Klotz Rosa, Merz Daniela, Michalski Christoph, Klaiber Ulla, Montorsi Marco, Nappo Gennaro, Ikenaga Naoki, Scornamiglio Pasquale, Andersson Bodil, Jeffery Fraser, Halloran Daniel, Padbury Robert, Siriwardena Ajith K, Barreto Savio George, Gianotti Luca, Oláh Attila, Halloran Christopher M, Connor Saxon, Andersson Roland, Izbicki Jakob R, Nakamura Masafumi, Zerbi Alessandro, Abu Hilal Mohammad, Loos Martin, Yeo Charles J, Miao Yi, Falconi Massimo, Dervenis Christos, Neoptolemos John P, Büchler Markus W, Besselink Marc G, Ferrone Cristina, Hackert Thilo, Salvia Roberto, Shrikhande Shailesh V, Strobel Oliver, Werner Jens, Wolfgang Christopher L, Marchegiani Giovanni
Department of Surgery, Fondazione Poliambulanza, Brescia, Italy.
Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy.
Ann Surg. 2024 Oct 22. doi: 10.1097/SLA.0000000000006569.
To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD).
In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system.
This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States. PPAP diagnosis required the following three parameters: (1) postoperative serum hyperamylasemia /hyperlipasemia (POH) persisting on postoperative days 1 and 2, (2) radiologic alterations consistent with PPAP, and (3) a clinically relevant deterioration in the patient's condition. To validate the grading system, clinical and economic parameters were analyzed across all grades.
Among 2902 patients undergoing PD, 7.5% (n=218) developed PPAP (6.3% grade B and 1.2% grade C). POH occurred in 24.1% of patients. Hospital stay was associated with PPAP grades (No POH/PPAP 10 days (IQR 7-17) days, grade B 22 days (IQR 15-34) days, and grade C 43 days (IQR 27-54) days; P<0.001), as well as intensive care unit admission (No POH/PPAP 5.4%, grade B 12.6%, grade C 82.9%; P<0.010), and hospital readmission rates (No POH/PPAP 7.3%, grade B 16.1%, grade C 18.5%; P<0.05). Costs of grade B and C PPAP were 2 and 11 times greater than uncomplicated clinical course, resp. (P<0.001).
This first prospective, international validation study of the ISGPS definition and grading system for PPAP highlighted the relevant clinical and financial implications of this condition. These results stress the importance of routine screening for PPAP in patients undergoing PD.
验证胰十二指肠切除术后（PD）胰瘘国际研究小组（ISGPS）的定义和分级系统。
2022年，国际胰腺手术研究小组（ISGPS）定义了胰十二指肠切除术后急性胰腺炎（PPAP），并建议对其诊断标准和分级系统进行前瞻性验证。
这是一项前瞻性、国际性、多中心研究，纳入了欧洲、亚洲、大洋洲和美国17家胰腺转诊中心接受PD手术的患者。PPAP的诊断需要以下三个参数：（1）术后第1天和第2天持续存在的术后血清高淀粉酶血症/高脂肪酶血症（POH），（2）与PPAP一致的影像学改变，以及（3）患者病情的临床相关恶化。为了验证分级系统，对所有级别患者的临床和经济参数进行了分析。
在2902例接受PD手术的患者中，7.5%（n = 218）发生了PPAP（B级6.3%，C级1.2%）。24.1%的患者出现了POH。住院时间与PPAP级别相关（无POH/PPAP患者为10天（四分位间距7 - 17天），B级为22天（四分位间距15 - 34天），C级为43天（四分位间距27 - 54天）；P < 0.001），以及重症监护病房入住率（无POH/PPAP患者为5.4%，B级为12.6%，C级为82.9%；P < 0.010）和医院再入院率（无POH/PPAP患者为7.3%，B级为16.1%，C级为18.5%；P < 0.05）。B级和C级PPAP的费用分别比无并发症临床病程高2倍和11倍（P < 0.001）。
这项对ISGPS的PPAP定义和分级系统进行的首次前瞻性、国际性验证研究突出了这种情况的相关临床和经济影响。这些结果强调了对接受PD手术患者进行PPAP常规筛查的重要性。
