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The evolution of post-operative pancreatic fistula (POPF) classification: A single-center experience.
Nappo, Gennaro; Capretti, Giovanni Luigi; Petitti, Tommasangelo; Gavazzi, Francesca; Ridolfi, Cristina; Cereda, Marco; Montorsi, Marco; Zerbi, Alessandro.
Afiliación
  • Nappo G; Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy. Electronic address: gennaro.nappo@humanitas.it.
  • Capretti GL; Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
  • Petitti T; Public Health and Statistics, Campus Bio-Medico University of Rome, Italy.
  • Gavazzi F; Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
  • Ridolfi C; Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
  • Cereda M; Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
  • Montorsi M; General and Digestive Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
  • Zerbi A; Pancreatic Surgery Unit, Humanitas Research Hospital and University, Rozzano, Milan, Italy.
Pancreatology ; 19(3): 449-455, 2019 Apr.
Article en En | MEDLINE | ID: mdl-30890308
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pancreatectomía / Complicaciones Posoperatorias / Fístula Pancreática / Pancreaticoduodenectomía Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Pancreatology Asunto de la revista: ENDOCRINOLOGIA / GASTROENTEROLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Suiza
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pancreatectomía / Complicaciones Posoperatorias / Fístula Pancreática / Pancreaticoduodenectomía Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Pancreatology Asunto de la revista: ENDOCRINOLOGIA / GASTROENTEROLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Suiza