Background
Many definitions are used in the literature for pancreatic anastomotic failure (PAF)
and delayed gastric emptying (DGE) after pancreatoduodenectomy (PD). To promote homogeneity,
published reports after 2005 have used the International Study Group on Pancreatic
Surgery (ISGPS) consensus definition for PAF and DGE; however, subsequent authors
have had to interpret or modify the ISGPS classification to make it useable. The solution
might be to create a web-based calculator, test it for ambiguity and reliability with
a large number of cases, and then make it available to the public.
Methods
Using 507 consecutive patients undergoing PD and 14 questions, we created a web-based
calculator based on the ISPGS classification to assess the incidence and grade of
clinical impact (none, moderate, or major deviation) for PAF and DGE. As the calculator's
formulas were tested, ambiguous terms were identified and resolved.
Results
The incidence for cases with clinical impact from PAF was 10% and from DGE it was
12%. Multivariate analysis identified 4 factors predictive for PAF: male sex, body
mass index (BMI) >30 kg/m2, soft gland texture, and main pancreatic duct size ≤3 mm. Predictive factors for
DGE included 2 factors: not using a surgical microscope, and simultaneous PAF.
Conclusion
A web-based calculator was developed to promote homogeneity of method for grading
of PAF and DGE after PD. Anyone with access to the web can now compare their results
to the current study.
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Article info
Publication history
Published online: December 17, 2009
Accepted:
October 6,
2009
Identification
Copyright
© 2010 Published by Elsevier Inc.
