Advertisement
Original article|Articles in Press

Clinical validation of the international study group of pancreatic surgery (ISGPS) definition for post-pancreatectomy acute pancreatitis

  • Juanita N. Chui
    Affiliations
    Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia

    Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia
    Search for articles by this author
  • Ai-Jen Yang
    Affiliations
    Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia
    Search for articles by this author
  • Christopher B. Nahm
    Affiliations
    Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia

    Department of Hepatobiliary, Pancreatic/Upper Gastrointestinal Surgery, Westmead Hospital, Sydney, Australia

    Surgical Innovations Unit, Westmead Hospital, Sydney NSW Australia
    Search for articles by this author
  • Saxon Connor
    Affiliations
    Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
    Search for articles by this author
  • Anthony J. Gill
    Affiliations
    Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia

    Kolling Institute of Medical Research, University of Sydney, Sydney, Australia

    NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Australia
    Search for articles by this author
  • Jaswinder S. Samra
    Affiliations
    Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia

    Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia

    Australian Pancreatic Centre, Sydney, Australia
    Search for articles by this author
  • Anubhav Mittal
    Correspondence
    Correspondence: Anubhav Mittal, Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, Australia.
    Affiliations
    Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia

    Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia

    Australian Pancreatic Centre, Sydney, Australia

    School of Medicine, The University of Notre Dame, Sydney, Australia
    Search for articles by this author
Published:February 02, 2023DOI:https://doi.org/10.1016/j.hpb.2023.01.014

      Abstract

      Background

      The diagnosis of postoperative or post-pancreatectomy acute pancreatitis (PPAP) is controversial. In 2021, the International Study Group of Pancreatic Surgery (ISGPS) published the first unifying definition and grading system for PPAP. This study sought to validate recent consensus criteria, using a cohort of patients undergoing pancreaticoduodenectomy (PD) in a high-volume pancreaticobiliary specialty unit.

      Methods

      All consecutive patients undergoing PD at a tertiary referral centre between January 2016 and December 2021 were retrospectively reviewed. Patients with serum amylase recorded within 48h from surgery were included for analysis. Postoperative data were extracted and evaluated against the ISGPS criteria, including the presence of postoperative hyperamylasaemia, radiologic features consistent with acute pancreatitis, and clinical deterioration.

      Results

      A total of 82 patients were evaluated. The overall incidence of PPAP was 32% (26/82) in this cohort, of which 3/26 demonstrated postoperative hyperamylasaemia and 23/26 had clinically relevant PPAP (Grade B or C) when correlated radiologic and clinical criteria.

      Conclusions

      This study is among the first to apply the recently published consensus criteria for PPAP diagnosis and grading to clinical data. While the results support their utility in establishing PPAP as a distinct post-pancreatectomy complication, there remains a need for future large-scale validation studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to HPB
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Marchegiani G.
        • Barreto S.G.
        • Bannone E.
        • Sarr M.
        • Vollmer C.M.
        • Connor S.
        • et al.
        Postpancreatectomy acute pancreatitis (PPAP): definition and grading from the international study group for pancreatic surgery (ISGPS).
        Ann Surgery. 2021;
        • Bannone E.
        • Andrianello S.
        • Marchegiani G.
        • Malleo G.
        • Paiella S.
        • Salvia R.
        • et al.
        Postoperative hyperamylasemia (POH) and acute pancreatitis after pancreatoduodenectomy (POAP): state of the art and systematic review.
        Surgery. 2021; 169: 377-387
        • Besselink M.
        • van Santvoort H.
        • Freeman M.
        • Gardner T.
        • Mayerle J.
        • Vege S.S.
        • et al.
        IAP/APA evidence-based guidelines for the management of acute pancreatitis.
        Pancreatology. 2013; 13: e1-e15
        • Connor S.
        Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection.
        HPB. 2016; 18: 642-651
        • Ramouz A.
        • Mehrabi A.
        • Loos M.
        Acute pancreatitis following major pancreatic resection.
        Surgery in Practice and Science. 2021; 5100036
        • Wente M.N.
        • Bassi C.
        • Dervenis C.
        • Fingerhut A.
        • Gouma D.J.
        • Izbicki J.R.
        • et al.
        Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).
        Surgery. 2007; 142: 761-768
        • Wente M.N.
        • Veit J.A.
        • Bassi C.
        • Dervenis C.
        • Fingerhut A.
        • Gouma D.J.
        • et al.
        Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition.
        Surgery. 2007; 142: 20-25
        • Bassi C.
        • Marchegiani G.
        • Dervenis C.
        • Sarr M.
        • Abu Hilal M.
        • Adham M.
        • et al.
        The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.
        Surgery. 2017; 161: 584-591
        • Nahm C.B.
        • Alzaabi S.
        • Sahni S.
        • Gill A.J.
        • Samra J.S.
        • Mittal A.
        Increased postoperative pancreatic fistula rate after distal pancreatectomy compared with pancreatoduodenectomy is attributable to a difference in acinar scores.
        J Hepatobiliary Pancreat Sci. 2021; 28: 533-541
        • Nahm C.B.
        • Brown K.M.
        • Townend P.J.
        • Calvin E.
        • Howell V.M.
        • Gill A.J.
        • et al.
        Acinar cell density at the pancreatic resection margin is associated with post-pancreatectomy pancreatitis and the development of postoperative pancreatic fistula.
        HPB. 2018; 20: 432-440
        • Ryska M.
        • Rudis J.
        Pancreatic fistula and postoperative pancreatitis after pancreatoduodenectomy for pancreatic cancer.
        Hepatobiliary Surg Nutr. 2014; 3: 268-275
        • Callery M.P.
        • Pratt W.B.
        • Kent T.S.
        • Chaikof E.L.
        • Vollmer C.M.
        A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy.
        J Am Coll Surg. 2013; 216: 1-14
        • Birgin E.
        • Reeg A.
        • Téoule P.
        • Rahbari N.N.
        • Post S.
        • Reissfelder C.
        • et al.
        Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?.
        HPB. 2019; 21: 972-980
        • Kühlbrey C.M.
        • Samiei N.
        • Sick O.
        • Makowiec F.
        • Hopt U.T.
        • Wittel U.A.
        Pancreatitis after pancreatoduodenectomy predicts clinically relevant postoperative pancreatic fistula.
        J Gastrointest Surg. 2017; 21: 330-338
        • Ikenaga N.
        • Ohtsuka T.
        • Nakata K.
        • Watanabe Y.
        • Mori Y.
        • Nakamura M.
        Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy.
        Surgery. 2021; 169: 732-737
        • Partelli S.
        • Tamburrino D.
        • Andreasi V.
        • Mazzocato S.
        • Crippa S.
        • Perretti E.
        Implications of increased serum amylase after pancreaticoduodenectomy: toward a better definition of clinically relevant postoperative acute pancreatitis.
        HPB. 2020; 22: 1645-1653
        • Laaninen M.
        • Bläuer M.
        • Vasama K.
        • Jin H.
        • Räty S
        • Sand J.
        • et al.
        The risk for immediate postoperative complications after pancreaticoduodenectomy is increased by high frequency of acinar cells and decreased by prevalent fibrosis of the cut edge of pancreas.
        Pancreas. 2012; 41: 957-961