A Simple Classification Of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula: A classification of the International Study Group of Pancreatic Surgery (ISGPS)
| Autor: | Thilo Hackert, Claudio Bassi, Keith D. Lillemoe, Oliver Strobel, Jürgen Weitz, Markus W. Büchler, Dezső Kelemen, Shailesh V. Shrikhande, Jakob R. Izbicki, Mustapha Adham, Christos Dervenis, Faik G. Uzunoglu, Massimo Falconi, Charles M. Vollmer, André L. Mihaljevic, Fabian Schuh, Giovanni Marchegiani, Carlos Fernandez-del Castillo, Christopher L. Wolfgang, Philip C. Müller, Markus K. Diener, Pascal Probst, Jens Werner, John P. Neoptolemos, Y. Miao, Marc G. Besselink, Maxwell T. Trudeau, Dejan Radenkovic, Kaspar Z'graggen, Helmut Friess |
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| Přispěvatelé: | Surgery, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism |
| Rok vydání: | 2021 |
| Předmět: |
Pancreatic duct
medicine.medical_specialty pancreatoduodenectomy business.industry Odds ratio medicine.disease Pancreatic surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Text mining pancreatic fistula Pancreatic fistula 030220 oncology & carcinogenesis Cohort Medicine pancreatic texture 030211 gastroenterology & hepatology Surgery Radiology pancreaticoduodenectomy business Pancreas Complication pancreatic duct |
| Zdroj: | Annals of surgery, 277(3), e597-e608. Lippincott Williams and Wilkins |
| ISSN: | 1528-1140 0003-4932 |
| Popis: | Objective: The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD). Summary Background Data: Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking. Methods: A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort. Results: Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62-5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively (P < 0.001). Conclusion: For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results. |
| Databáze: | OpenAIRE |
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