TY - JOUR
T1 - A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula
T2 - A classification of the International Study Group of Pancreatic Surgery
AU - Schuh, Fabian
AU - Mihaljevic, André L.
AU - Probst, Pascal
AU - Trudeau, Maxwell T.
AU - Müller, Philip C.
AU - Marchegiani, Giovanni
AU - Besselink, Marc G.
AU - Uzunoglu, Faik
AU - Izbicki, Jakob R.
AU - Falconi, Massimo
AU - Castillo, Carlos Fernandez Del
AU - Adham, Mustapha
AU - Z'Graggen, Kaspar
AU - Friess, Helmut
AU - Werner, Jens
AU - Weitz, Jürgen
AU - Strobel, Oliver
AU - Hackert, Thilo
AU - Radenkovic, Dejan
AU - Kelemen, Dezso
AU - Wolfgang, Christopher
AU - Miao, Y. I.
AU - Shrikhande, Shailesh V.
AU - Lillemoe, Keith D.
AU - Dervenis, Christos
AU - Bassi, Claudio
AU - Neoptolemos, John P.
AU - Diener, Markus K.
AU - Vollmer, Charles M.
AU - Büchler, Markus W.
N1 - Funding Information:
Funding: No funding has been received for this work.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - 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.
AB - 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.
KW - pancreatic duct
KW - pancreatic fistula
KW - pancreatic texture
KW - pancreaticoduodenectomy
KW - pancreatoduodenectomy
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U2 - 10.1097/SLA.0000000000004855
DO - 10.1097/SLA.0000000000004855
M3 - Article
C2 - 33914473
AN - SCOPUS:85147536543
SN - 0003-4932
VL - 277
SP - E597-E608
JO - Annals of surgery
JF - Annals of surgery
IS - 3
ER -