Staging and Postoperative Outcomes Using the International Study Group of Pancreatic Surgery (ISGPS) Classifications

Reference work entry

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).

Keywords

Pancreatic surgery Postoperative pancreatic fistula Postpancreatectomy hemorrhage Delayed gastric emptying Definition 

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Visceral, Thoracic and Vascular SurgeryUniversity Hospital Carl Gustav Carus, Technische Universität DresdenDresdenGermany

Section editors and affiliations

  • James L. Abbruzzese
    • 1
  • Raul A. Urrutia
    • 2
  • John Neoptolemos
    • 3
  • Markus W. Büchler
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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