A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

作者：Fabian Schuh, André L. Mihaljević, Pascal Probst, Maxwell T. Trudeau, Philip C. Müller, Giovanni Marchegiani, Marc G. Besselink, Faik Güntac Uzunoglu, Jakob Robert Izbicki, Massimo Falconi, Carlos Fernández‐del Castillo, Mustapha Adham, Kaspar Z’graggen, Helmut Frieß, Jens Werner, Jürgen Weitz, Oliver Strobel, Thilo Hackert, Dejan V. Radenkovic, Dezső Kelemen, Christopher Lee Wolfgang, Yi Miao, Shailesh Vinayak Shrikhande, Keith D. Lillemoe, Christos Dervenis, Claudio Bassi, John P. Neoptolemos, Markus K. Diener, Charles M. Vollmer, Markus Wolfgang Büchler · 发表于：Annals of Surgery · 年份：2021 · DOI：10.1097/sla.0000000000004855 · 被引用次数：245 · 研究领域：Pancreatic and Hepatic Oncology Research、Pancreatitis Pathology and Treatment、Gallbladder and Bile Duct Disorders

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 independe...