Detailed Abstract
[Plenary Session]
[PL 3] A retrospective multicenter validation of 2016 ISGPS classification and grading system of postoperative pancreatic fistula by analyzing 522 consecutive cases of pancreaticoduodenectomy
Jingyong XU1, 2, Aoran ZHANG1, Xiaodong TIAN1, Hao HU3, Xi CAO4, Jian CHEN2, Junmin WEI2, Yinmo YANG1
1General Surgery, Peking University First Hospital, China
2General Surgery, Beijing Hospital, National Center of Gerontology, China
3General Surgery, Aerospace Central Hospital, China
4General Surgery, Ordos Central Hospital, China
Introduction : In 2016, ISGPS proposed an updated definition for postoperative pancreatic fistula (POPF). The definition of B-POPF varies widely and B and C-POPF criteria may overlap to a certain degree.
Methods : A retrospective study of 522 consecutive cases underwent PD in four major hospitals between May 2013 and May 2018 was carried out. Risk factors were examined with univariate and multivariate analysis. B-POPFs were subclassified into 2 classes (B1: non-interventional; B2: interventional). Outcomes were analyzed between subgroups.
Results : 522 cases were recruited. B-POPF rate is 27.4%; C-POPF rate is 5.7%. Reoperation rate is 4.8%. Perioperative mortality is 3.3%. 8 cases were re-admitted in 30 days. The length of stay (LOS) is 27.6?0.0 days. Logistic regression analysis identified 3 independent factors: diameter of pancreatic duct [OR=0.693, 95%CI=(0.559, 0.858)], laparoscopic procedure [OR=4.68, 95%CI=(1.034, 21.083) ] and PDCA/CP pathology [OR=0.397, 95%CI=(0.195, 0.811) ]. In the comparison between B1 and B2-POPF, there are statistic significance in reoperation rate (1.69% vs. 15.0%, P=0.001); mortality (0 vs. 17.5%, P=0.000); hemorrhage (11.9% vs. 45.0%, P=0.000); ICU stay (1.01?.89 vs. 5.45?2.11, P=0.026); LOS (35.80?1.75 vs. 47.78?3.75, P=0.041) and cost (USD 27762.57?2433.72 vs. 49433.39?7029.22, P=0.004). The comparison between B2 and C-POPF showed significance between bile leakage (37.5% vs. 11.1%, P=0.041) and rate of reoperation (15.0% vs. 55.6%, P=0.001).
Conclusions : Diameter of pancreatic duct and PDCA/CA pathology are risk factors and laparoscopic procedure may reduce POPF. B-POPF is a heterogeneous entity.2 subclasses can be identified. Some B2-POPF have the same characters with C-POPF. These results will promote changes and researches for accurate grading.
Methods : A retrospective study of 522 consecutive cases underwent PD in four major hospitals between May 2013 and May 2018 was carried out. Risk factors were examined with univariate and multivariate analysis. B-POPFs were subclassified into 2 classes (B1: non-interventional; B2: interventional). Outcomes were analyzed between subgroups.
Results : 522 cases were recruited. B-POPF rate is 27.4%; C-POPF rate is 5.7%. Reoperation rate is 4.8%. Perioperative mortality is 3.3%. 8 cases were re-admitted in 30 days. The length of stay (LOS) is 27.6?0.0 days. Logistic regression analysis identified 3 independent factors: diameter of pancreatic duct [OR=0.693, 95%CI=(0.559, 0.858)], laparoscopic procedure [OR=4.68, 95%CI=(1.034, 21.083) ] and PDCA/CP pathology [OR=0.397, 95%CI=(0.195, 0.811) ]. In the comparison between B1 and B2-POPF, there are statistic significance in reoperation rate (1.69% vs. 15.0%, P=0.001); mortality (0 vs. 17.5%, P=0.000); hemorrhage (11.9% vs. 45.0%, P=0.000); ICU stay (1.01?.89 vs. 5.45?2.11, P=0.026); LOS (35.80?1.75 vs. 47.78?3.75, P=0.041) and cost (USD 27762.57?2433.72 vs. 49433.39?7029.22, P=0.004). The comparison between B2 and C-POPF showed significance between bile leakage (37.5% vs. 11.1%, P=0.041) and rate of reoperation (15.0% vs. 55.6%, P=0.001).
Conclusions : Diameter of pancreatic duct and PDCA/CA pathology are risk factors and laparoscopic procedure may reduce POPF. B-POPF is a heterogeneous entity.2 subclasses can be identified. Some B2-POPF have the same characters with C-POPF. These results will promote changes and researches for accurate grading.
SESSION
Plenary Session
Room A 4/6/2019 11:30 AM - 11:45 AM