Abstract
The International Study Group of Pancreatic Surgery (ISGPS) established consensus definitions of postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), and delayed gastric emptying (DGE) and thereby covered the major specific complications of pancreatic surgery. A threefold increase of the amylase content in abdominal wound drains compared with serum level on or after the third postoperative day defines POPF; early and late (>24 h) PPH is defined by mild and moderate bleeding according to the drop of hemoglobin or the need for transfusion requirement, and the inability to tolerate solid oral intake after the first postoperative week defines DGE. All three consensus definitions are classified into three grades: A, B, and C. These grades stratify the clinical effect (the illness of the patient and the need for intervention), associated mortality, hospital stay, and economic costs. All definitions have been validated using large cohorts of patients and show different outcome data at different centers, even when high-volume centers are compared with each other. A minor degree of equivocacy of the original definitions is also acknowledged. The clinically relevant grades are most important, and the prevalence of grade B/C complications based on the ISGPS definitions occurs at the following median rates: 12–20% (POPF), 2–11% (PPH), and 6–17% (DGE).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Harnoss JC, Ulrich AB, Harnoss JM, Diener MK, Büchler MW, Welsch T. Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery. 2014;155(1):47–57.
Hartwig W, Hackert T, Hinz U, Hassenpflug M, Strobel O, Büchler MW, Werner J. Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg. 2009;250(1):81–7.
Bassi C, Butturini G, Molinari E, Mascetta G, Salvia R, Falconi M, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg. 2004;21(1):54–9.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.
Hackert T, Hinz U, Pausch T, Fesenbeck I, Strobel O, Schneider L, et al. Postoperative pancreatic fistula: we need to redefine grades B and C. Surgery. 2016;159(3):872–7.
Daskalaki D, Butturini G, Molinari E, Crippa S, Pederzoli P, Bassi C. A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients. Langenbeck’s Arch Surg. 2011;396(1):91–8.
Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM. Clinical and economic validation of the international study group of pancreatic fistula (ISGPF) classification scheme. Ann Surg. 2007;245(3):443–51.
Welsch T, Müssle B, Distler M, Knoth H, Weitz J, Häckl D. Cost-effectiveness comparison of prophylactic octreotide and pasireotide for prevention of fistula after pancreatic surgery. Langenbeck’s Arch Surg. 2016;401:1027–35.
Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet. 2011;377(9776):1514–22.
Keck T, Wellner UF, Bahra M, Klein F, Sick O, Niedergethmann M, et al. Pancreaticogastrostomy versus pancreatojejunostomy for reconstruction after pancreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg. 2015;263(3):440–9.
Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev. 2013;4:CD008370.
Allen PJ, Gönen M, Brennan MF, Bucknor AA, Robinson LM, Pappas MM, et al. Pasireotide for postoperative pancreatic fistula. N Engl J Med. 2014;370(21):2014–22.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.
Welsch T, Eisele H, Zschäbitz S, Hinz U, Büchler MW, Wente MN. Critical appraisal of the international study group of pancreatic surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy. Langenbeck’s Arch Surg. 2011;396(6):783–91.
Grützmann R, Rückert F, Hippe-Davies N, Distler M, Saeger HD. Evaluation of the international study group of pancreatic surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery. 2012;151(4):612–20.
Tol JA, Busch OR, van Delden OM, van Lienden KP, van Gulik TM, Gouma DJ. Shifting role of operative and nonoperative interventions in managing complications after pancreatoduodenectomy: what is the preferred intervention? Surgery. 2014;156(3):622–31.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery. 2007;142(5):761–8.
Welsch T, Borm M, Degrate L, Hinz U, Büchler MW, Wente MN. Evaluation of the international study group of pancreatic surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg. 2010;97(7):1043–50.
Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg. 2015;19(9):1572–80.
Sahora K, Morales-Oyarvide V, Thayer SP, Ferrone CR, Warshaw AL, Lillemoe KD, Fernández-Del CC. The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy. Am J Surg. 2015;209(6):1028–35.
Su AP, Cao SS, Zhang Y, Zhang ZD, Hu WM, Tian BL. Does antecolic reconstruction for duodenojejunostomy improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? A systematic review and meta-analysis. World J Gastroenterol. 2012;18(43):6315–23.
Hackert T, Bruckner T, Dörr-Harim C, Diener MK, Knebel P, Hartwig W, et al. Pylorus resection or pylorus preservation in partial pancreaticoduodenectomy (PROPP study): study protocol for a randomized controlled trial. Trials. 2013;14:44.
Hackert T, Hinz U, Hartwig W, Strobel O, Fritz S, Schneider L, et al. Pylorus resection in partial pancreaticoduodenectomy: impact on delayed gastric emptying. Am J Surg. 2013;206(3):296–9.
Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, Yamaue H. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg. 2011;253(3):495–501.
de Rooij T, Lu MZ, Steen MW, Gerhards MF, Dijkgraaf MG, Busch OR, et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg. 2016;10
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2018 Springer Science+Business Media, LLC, part of Springer Nature
About this entry
Cite this entry
Welsch, T., Weitz, J. (2018). Staging and Postoperative Outcomes Using the International Study Group of Pancreatic Surgery (ISGPS) Classifications. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7193-0_57
Download citation
DOI: https://doi.org/10.1007/978-1-4939-7193-0_57
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-7191-6
Online ISBN: 978-1-4939-7193-0
eBook Packages: Biomedical and Life SciencesReference Module Biomedical and Life Sciences