Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)

Giovanni Marchegiani; Savio George Barreto; Elisa Bannone; Michael Sarr; Charles M. Vollmer; Saxon Connor; Massimo Falconi; Marc G. Besselink; Roberto Salvia; Christopher L. Wolfgang; Nicholas J. Zyromski; Charles J. Yeo; Mustapha Adham; Ajith K. Siriwardena; Kyoichi Takaori; Mohammad Abu Hilal; Martin Loos; Pascal Probst; Thilo Hackert; Oliver Strobel; Olivier R.C. Busch; Keith D. Lillemoe; Yi Miao; Christopher M. Halloran; Jens Werner; Helmut Friess; Jakob R. Izbicki; Maximillian Bockhorn; Yogesh K. Vashist; Kevin Conlon; Ioannis Passas; Luca Gianotti; Marco Del Chiaro; Richard D. Schulick; Marco Montorsi; Attila Oláh; Giuseppe Kito Fusai; Alejandro Serrablo; Alessandro Zerbi; Abe Fingerhut; Roland Andersson; Robert Padbury; Christos Dervenis; John P. Neoptolemos; Claudio Bassi; Markus W. Büchler; Shailesh V. Shrikhande

doi:10.1097/SLA.0000000000005226

Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)

Giovanni Marchegiani, Savio George Barreto, Elisa Bannone, Michael Sarr, Charles M. Vollmer, Saxon Connor, Massimo Falconi, Marc G. Besselink, Roberto Salvia, Christopher L. Wolfgang, Nicholas J. Zyromski, Charles J. Yeo, Mustapha Adham, Ajith K. Siriwardena, Kyoichi Takaori, Mohammad Abu Hilal, Martin Loos, Pascal Probst, Thilo Hackert, Oliver StrobelOlivier R.C. Busch, Keith D. Lillemoe, Yi Miao, Christopher M. Halloran, Jens Werner, Helmut Friess, Jakob R. Izbicki, Maximillian Bockhorn, Yogesh K. Vashist, Kevin Conlon, Ioannis Passas, Luca Gianotti, Marco Del Chiaro, Richard D. Schulick, Marco Montorsi, Attila Oláh, Giuseppe Kito Fusai, Alejandro Serrablo, Alessandro Zerbi, Abe Fingerhut, Roland Andersson, Robert Padbury, Christos Dervenis, John P. Neoptolemos, Claudio Bassi, Markus W. Büchler, Shailesh V. Shrikhande

School of Medicine

Research output: Contribution to journal › Review article › peer-review

Abstract

Objective:The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.Background::PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.Methods:The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.Results:We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.Discussions:The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.

Original language	English (US)
Pages (from-to)	663-672
Number of pages	10
Journal	Annals of surgery
Volume	275
Issue number	4
DOIs	https://doi.org/10.1097/SLA.0000000000005226
State	Published - Apr 1 2022

Keywords

International Study Group for Pancreatic Surgery
definition
postpancreatectomy acute pancreatitis

ASJC Scopus subject areas

Surgery

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10.1097/SLA.0000000000005226

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Marchegiani, G., Barreto, S. G., Bannone, E., Sarr, M., Vollmer, C. M., Connor, S., Falconi, M., Besselink, M. G., Salvia, R., Wolfgang, C. L., Zyromski, N. J., Yeo, C. J., Adham, M., Siriwardena, A. K., Takaori, K., Hilal, M. A., Loos, M., Probst, P., Hackert, T., ... Shrikhande, S. V. (2022). Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS). Annals of surgery, 275(4), 663-672. https://doi.org/10.1097/SLA.0000000000005226

Marchegiani, G, Barreto, SG, Bannone, E, Sarr, M, Vollmer, CM, Connor, S, Falconi, M, Besselink, MG, Salvia, R, Wolfgang, CL, Zyromski, NJ, Yeo, CJ, Adham, M, Siriwardena, AK, Takaori, K, Hilal, MA, Loos, M, Probst, P, Hackert, T, Strobel, O, Busch, ORC, Lillemoe, KD, Miao, Y, Halloran, CM, Werner, J, Friess, H, Izbicki, JR, Bockhorn, M, Vashist, YK, Conlon, K, Passas, I, Gianotti, L, Del Chiaro, M, Schulick, RD, Montorsi, M, Oláh, A, Fusai, GK, Serrablo, A, Zerbi, A, Fingerhut, A, Andersson, R, Padbury, R, Dervenis, C, Neoptolemos, JP, Bassi, C, Büchler, MW & Shrikhande, SV 2022, 'Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)', Annals of surgery, vol. 275, no. 4, pp. 663-672. https://doi.org/10.1097/SLA.0000000000005226

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title = "Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)",

abstract = "Objective:The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.Background::PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.Methods:The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.Results:We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.Discussions:The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.",

keywords = "International Study Group for Pancreatic Surgery, definition, postpancreatectomy acute pancreatitis",

author = "Giovanni Marchegiani and Barreto, {Savio George} and Elisa Bannone and Michael Sarr and Vollmer, {Charles M.} and Saxon Connor and Massimo Falconi and Besselink, {Marc G.} and Roberto Salvia and Wolfgang, {Christopher L.} and Zyromski, {Nicholas J.} and Yeo, {Charles J.} and Mustapha Adham and Siriwardena, {Ajith K.} and Kyoichi Takaori and Hilal, {Mohammad Abu} and Martin Loos and Pascal Probst and Thilo Hackert and Oliver Strobel and Busch, {Olivier R.C.} and Lillemoe, {Keith D.} and Yi Miao and Halloran, {Christopher M.} and Jens Werner and Helmut Friess and Izbicki, {Jakob R.} and Maximillian Bockhorn and Vashist, {Yogesh K.} and Kevin Conlon and Ioannis Passas and Luca Gianotti and {Del Chiaro}, Marco and Schulick, {Richard D.} and Marco Montorsi and Attila Ol{\'a}h and Fusai, {Giuseppe Kito} and Alejandro Serrablo and Alessandro Zerbi and Abe Fingerhut and Roland Andersson and Robert Padbury and Christos Dervenis and Neoptolemos, {John P.} and Claudio Bassi and B{\"u}chler, {Markus W.} and Shrikhande, {Shailesh V.}",

year = "2022",

month = apr,

day = "1",

doi = "10.1097/SLA.0000000000005226",

language = "English (US)",

volume = "275",

pages = "663--672",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Lippincott Williams and Wilkins",

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TY - JOUR

T1 - Postpancreatectomy Acute Pancreatitis (PPAP)

T2 - Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)

AU - Marchegiani, Giovanni

AU - Barreto, Savio George

AU - Bannone, Elisa

AU - Sarr, Michael

AU - Vollmer, Charles M.

AU - Connor, Saxon

AU - Falconi, Massimo

AU - Besselink, Marc G.

AU - Salvia, Roberto

AU - Wolfgang, Christopher L.

AU - Zyromski, Nicholas J.

AU - Yeo, Charles J.

AU - Adham, Mustapha

AU - Siriwardena, Ajith K.

AU - Takaori, Kyoichi

AU - Hilal, Mohammad Abu

AU - Loos, Martin

AU - Probst, Pascal

AU - Hackert, Thilo

AU - Strobel, Oliver

AU - Busch, Olivier R.C.

AU - Lillemoe, Keith D.

AU - Miao, Yi

AU - Halloran, Christopher M.

AU - Werner, Jens

AU - Friess, Helmut

AU - Izbicki, Jakob R.

AU - Bockhorn, Maximillian

AU - Vashist, Yogesh K.

AU - Conlon, Kevin

AU - Passas, Ioannis

AU - Gianotti, Luca

AU - Del Chiaro, Marco

AU - Schulick, Richard D.

AU - Montorsi, Marco

AU - Oláh, Attila

AU - Fusai, Giuseppe Kito

AU - Serrablo, Alejandro

AU - Zerbi, Alessandro

AU - Fingerhut, Abe

AU - Andersson, Roland

AU - Padbury, Robert

AU - Dervenis, Christos

AU - Neoptolemos, John P.

AU - Bassi, Claudio

AU - Büchler, Markus W.

AU - Shrikhande, Shailesh V.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Objective:The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.Background::PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.Methods:The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.Results:We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.Discussions:The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.

AB - Objective:The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.Background::PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.Methods:The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.Results:We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.Discussions:The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.

KW - International Study Group for Pancreatic Surgery

KW - definition

KW - postpancreatectomy acute pancreatitis

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DO - 10.1097/SLA.0000000000005226

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JO - Annals of surgery

JF - Annals of surgery

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Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)

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Keywords

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