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Postoperative pancreatic fistula: An international study group (ISGPF) definition

  • Claudio Bassi
    Correspondence
    Reprint requests: Claudio Bassi, MD, Surgical and Gastroenterological Department, Hospital “G.B. Rossi,” University of Verona, 37134-Verona, Italy.
    Affiliations
    From the Surgical and Gastroenterological Department, Hospital “G.B. Rossi” University of Verona
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  • Christos Dervenis
    Affiliations
    Surgical Department, Agia Olga Hospital, Athens
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  • Giovanni Butturini
    Affiliations
    From the Surgical and Gastroenterological Department, Hospital “G.B. Rossi” University of Verona
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  • Abe Fingerhut
    Affiliations
    General and Digestive Surgery Unit, Centre Hospitalier Intercommunal, Poissy
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  • Charles Yeo
    Affiliations
    Surgical Department, Johns Hopkins Hospital, Baltimore, Md
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  • Jakob Izbicki
    Affiliations
    Surgical Department, University Hospital, Hamburg
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  • John Neoptolemos
    Affiliations
    Surgical Department, Royal University Hospital, Liverpool
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  • Michael Sarr
    Affiliations
    Surgical Department, Mayo Clinic, Rochester
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  • William Traverso
    Affiliations
    Surgical Department, Virginia Mason Clinic, Seattle
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  • Marcus Buchler
    Affiliations
    Surgical Department, University Hospital, Heidelberg
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  • for the International Study Group on Pancreatic Fistula Definition
    Author Footnotes
    ∗ Members of the International Study Group on Pancreatic Fistula Definition (ISGPF): Claudio Bassi (Verona, Italy), Christos Dervenis (Athens, Greece), Abe Fingerhut (Poissy, France), Charles Yeo (Baltimore, Maryland, USA), John Neoptolemos MD (Liverpool, UK), Masayuki Imamura (Kyoto, Japan), Michael Sarr (Rochester, NY, USA), William Traverso (Seattle, Washington, USA), Marcus Buchler (Heidelberg, Germany), Keith Lillemoe (Indianapolis, Indiana, USA), Carlos Fernandez de Castillo (Boston, Massachusetts, USA), Laureano Fernanadez Cruz (Barcelona, Spain), Clem Imrie (Glasgow, UK), Roland Andersson (Lund, Sweden), Dirk Gouma (Amsterdam, Netherland), Milicevic Miroslav and Lijli Petrijonevic (Belgrade, Yugoslavia), Andren Ake Sandberg (Gothemburg, Sweden), Tadahiro Takada (Tokio, Japan), Valerio Di Carlo (Milan, Italy), Josè Eduardo Cunha (San Paulo, Brasil), Rob Petbury (Adelaide, Australia), Helmut Friess (Heidelberg, Germany), Krzysztof Bielecki (Warsaw, Poland), Efthimios Chatzitheoklitos (Thessaloniki, Greece), Gregor Tsiotos (Athens, Greece), Colin Johnson (Southampton, UK), Mike Mac Mahon (Leeds, UK), John Bramis (Athens, Greece), Attila Olah (Gyor, Hungary), Tibor Tihani (Budapest, Hungary), Robin Williamson (London, UK), Jakob Izbicki (Hamburg, Germany), Giovanni Butturini (Verona, Italy), Roberto Salvia (Verona, Italy), Nora Sartori (Verona, Italy), Massimo Falconi (Verona, Italy), Paolo Pederzoli (Verona, Italy).
  • Author Footnotes
    ∗ Members of the International Study Group on Pancreatic Fistula Definition (ISGPF): Claudio Bassi (Verona, Italy), Christos Dervenis (Athens, Greece), Abe Fingerhut (Poissy, France), Charles Yeo (Baltimore, Maryland, USA), John Neoptolemos MD (Liverpool, UK), Masayuki Imamura (Kyoto, Japan), Michael Sarr (Rochester, NY, USA), William Traverso (Seattle, Washington, USA), Marcus Buchler (Heidelberg, Germany), Keith Lillemoe (Indianapolis, Indiana, USA), Carlos Fernandez de Castillo (Boston, Massachusetts, USA), Laureano Fernanadez Cruz (Barcelona, Spain), Clem Imrie (Glasgow, UK), Roland Andersson (Lund, Sweden), Dirk Gouma (Amsterdam, Netherland), Milicevic Miroslav and Lijli Petrijonevic (Belgrade, Yugoslavia), Andren Ake Sandberg (Gothemburg, Sweden), Tadahiro Takada (Tokio, Japan), Valerio Di Carlo (Milan, Italy), Josè Eduardo Cunha (San Paulo, Brasil), Rob Petbury (Adelaide, Australia), Helmut Friess (Heidelberg, Germany), Krzysztof Bielecki (Warsaw, Poland), Efthimios Chatzitheoklitos (Thessaloniki, Greece), Gregor Tsiotos (Athens, Greece), Colin Johnson (Southampton, UK), Mike Mac Mahon (Leeds, UK), John Bramis (Athens, Greece), Attila Olah (Gyor, Hungary), Tibor Tihani (Budapest, Hungary), Robin Williamson (London, UK), Jakob Izbicki (Hamburg, Germany), Giovanni Butturini (Verona, Italy), Roberto Salvia (Verona, Italy), Nora Sartori (Verona, Italy), Massimo Falconi (Verona, Italy), Paolo Pederzoli (Verona, Italy).

      Background

      Postoperative pancreatic fistula (POPF) is still regarded as a major complication. The incidence of POPF varies greatly in different reports, depending on the definition applied at each surgical center. Our aim was to agree upon an objective and internationally accepted definition to allow comparison of different surgical experiences.

      Methods

      An international panel of pancreatic surgeons, working in well-known, high-volume centers, reviewed the literature on the topic and worked together to develop a simple, objective, reliable, and easy-to-apply definition of POPF, graded primarily on clinical impact.

      Results

      A POPF represents a failure of healing/sealing of a pancreatic-enteric anastomosis or a parenchymal leak not directly related to an anastomosis. An all-inclusive definition is a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity. Three different grades of POPF (grades A, B, C) are defined according to the clinical impact on the patient's hospital course.

      Conclusions

      The present definition and clinical grading of POPF should allow realistic comparisons of surgical experiences in the future when new techniques, new operations, or new pharmacologic agents that may impact surgical treatment of pancreatic disorders are addressed.
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