A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula
Year: 2021
Type: article
Study design: Systematic Review
Abstract: OBJECTIVE: The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD). SUMMARY BACKGROUND DATA: Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking. METHODS: A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort. RESULTS: Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62-5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively ( P < 0.001). CONCLUSION: For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results.
Source: Annals of Surgery
Authors: Fabian Schuh, André L. Mihaljevic, Pascal Probst, Maxwell T. Trudeau, Philip C. Müller, Giovanni Marchegiani, Marc G. Besselink, Faik Uzunoglu, Jakob R. Izbicki, Massimo Falconi, Carlos Fernandez-del Castillo, Mustapha Adham, Kaspar Z’graggen, Helmut Friess, Jens Werner, Jürgen Weitz, Oliver Strobel, Thilo Hackert, Dejan Radenkovic, Dezso˝ Kelemen, Christopher Wolfgang, Y. I. Miao, Shailesh V. Shrikhande, Keith D. Lillemoe, Christos Dervenis, Claudio Bassi, John P. Neoptolemos, Markus K. Diener, Charles M. Vollmer, Markus W. Büchler
Institutions: Heidelberg University, University of Pennsylvania, Hirslanden Klinik Beau-Site, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, University Medical Center Hamburg-Eppendorf, Vita-Salute San Raffaele University, Harvard University, Massachusetts General Hospital, Hôpital Edouard Herriot, TUM Klinikum, Technical University of Munich, Ludwig-Maximilians-Universität München, University Hospital Carl Gustav Carus, University of Belgrade, Univerzitetski Klinički Centar Srbije, University of Pecs, Johns Hopkins University, Johns Hopkins Medicine, Jiangsu Province Hospital, Nanjing Medical University, Tata Memorial Hospital, University of Cyprus
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W3136922706