Alvaro A Duarte Garcés1, Stefano Andrianello2, Giovanni Marchegiani2, Roberta Piccolo2, Erica Secchettin2, Salvatore Paiella2, Giuseppe Malleo2, Roberto Salvia3, Claudio Bassi2. 1. Departamento Cirugía Hepato Biliar y Pancreatica, Hospital Pablo Tobon Uribe, Medellìn, Colombia; General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. 2. General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. 3. General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. Electronic address: roberto.salvia@univr.it.
Abstract
BACKGROUND: Post-pancreatectomy hemorrhage (PPH) remains a major complication. The aim of this study was to reappraise the International Study Group of Pancreatic Surgery (ISGPS) classification. METHODS: The clinical utility of the ISGPS classification was tested on consecutive pancreatic resections performed at the Pancreas Institute of the University of Verona Hospital. RESULTS: PPH occurred in 65 of the 2429 patients (6.8%) undergoing pancreatic resection. Outcome of patients without PPH and with grade A PPH were comparable in terms of mortality, length of stay, ICU stay and readmission. Patients with grade B late and mild and grade B early and severe PPH had similar hospital stay and mortality rates, but differed in relaparotomy rate (10.1 vs. 81.2%, p < 0.01). Replacing "time of PPH onset" criterion with post-operative pancreatic fistula (POPF), severe PPH alone, mild PPH/POPF and severe PPH/POPF differed significantly for hospital stay (14 vs. 23 vs. 35 days, p < 0.01) and mortality rate (0 vs. 4 vs. 25%, p = 0.05). CONCLUSION: Grade A PPH shared the same outcome of patients without PPH. Grade B PPH included two categories of patients with different treatment modalities. The use of "concomitant POPF" instead of "time of onset" segregated three discrete categories that differed significantly in terms of clinical outcomes and management.
BACKGROUND: Post-pancreatectomy hemorrhage (PPH) remains a major complication. The aim of this study was to reappraise the International Study Group of Pancreatic Surgery (ISGPS) classification. METHODS: The clinical utility of the ISGPS classification was tested on consecutive pancreatic resections performed at the Pancreas Institute of the University of Verona Hospital. RESULTS: PPH occurred in 65 of the 2429 patients (6.8%) undergoing pancreatic resection. Outcome of patients without PPH and with grade A PPH were comparable in terms of mortality, length of stay, ICU stay and readmission. Patients with grade B late and mild and grade B early and severe PPH had similar hospital stay and mortality rates, but differed in relaparotomy rate (10.1 vs. 81.2%, p < 0.01). Replacing "time of PPH onset" criterion with post-operative pancreatic fistula (POPF), severe PPH alone, mild PPH/POPF and severe PPH/POPF differed significantly for hospital stay (14 vs. 23 vs. 35 days, p < 0.01) and mortality rate (0 vs. 4 vs. 25%, p = 0.05). CONCLUSION: Grade A PPH shared the same outcome of patients without PPH. Grade B PPH included two categories of patients with different treatment modalities. The use of "concomitant POPF" instead of "time of onset" segregated three discrete categories that differed significantly in terms of clinical outcomes and management.
Authors: Leon Bruder; Larissa Schawe; Bernhard Gebauer; Jan Paul Frese; Maximilian de Bucourt; Katharina Beyer; Johann Pratschke; Andreas Greiner; Safwan Omran Journal: Curr Oncol Date: 2022-03-30 Impact factor: 3.109
Authors: Hussameldin M Nour; Dimitra V Peristeri; Amiya Ahsan; Shehram Shafique; Prof Mansoor Khan; Muhammad S Sajid Journal: Ann Med Surg (Lond) Date: 2022-09-14