Giovanni Marchegiani1, Savio George Barreto2, Elisa Bannone1, Michael Sarr3, Charles M Vollmer4, Saxon Connor5, Massimo Falconi6, Marc G Besselink7, Roberto Salvia1, Christopher L Wolfgang8, Nicholas J Zyromski9, Charles J Yeo10, Mustapha Adham11, Ajith K Siriwardena12, Kyoichi Takaori13, Mohammad Abu Hilal14, Martin Loos15, Pascal Probst15, Thilo Hackert15, Oliver Strobel15, Olivier R C Busch7, Keith D Lillemoe16, Yi Miao17, Christopher M Halloran18, Jens Werner19, Helmut Friess20, Jakob R Izbicki21, Maximillian Bockhorn22, Yogesh K Vashist23, Kevin Conlon24, Ioannis Passas25, Luca Gianotti26, Marco Del Chiaro27, Richard D Schulick28, Marco Montorsi29, Attila Oláh30, Giuseppe Kito Fusai31, Alejandro Serrablo32, Alessandro Zerbi26, Abe Fingerhut33, Roland Andersson28, Robert Padbury2, Christos Dervenis24, John P Neoptolemos15, Claudio Bassi1, Markus W Büchler15, Shailesh V Shrikhande26. 1. Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy. 2. Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia. 3. Mayo Clinic Department of General Surgery, Rochester, NY. 4. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5. Department of Surgery, Christchurch Hospital, Christchurch, New Zealand. 6. Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. 7. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 8. Department of Surgery, NYU Grossman School of Medicine, New York, NY. 9. Indiana University School of Medicine, Indiana University Health, Indianapolis, IN. 10. Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. 11. Digestive Surgery Department, Lyon Civil Hospital, Lyon, France. 12. Manchester Royal Infirmary, Manchester, UK. 13. Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. 14. Department of Surgery, Fondazione Poliambulanza, Brescia, Italy. 15. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. 16. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 17. Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, PR China. 18. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. 19. Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians-University, Munich, Germany. 20. Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany. 21. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 22. Asklepios Harzklinik, Goslar, Germany. 23. Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland. 24. Department of Surgery, AGIA OLGA Hospital, Athens, Greece. 25. School of Medicine and Surgery, Milano - Bicocca University, and Department of Surgery, San Gerardo Hospital, Monza, Italy. 26. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. 27. Department of Surgery, Humanitas University and Research Hospital IRCCS, Milan, Italy. 28. The Petz Aladar Hospital, Gyor, Hungary. 29. Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK. 30. Department of Surgery, Miguel Servet University Hospital, Paseo Isabel la Catolica, Zaragoza, Spain. 31. University of Graz Hospital, Surgical Research Unit, Graz, Austria. 32. Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden. 33. Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Abstract
OBJECTIVE: The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison. BACKGROUND: PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking. METHODS: The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021. RESULTS: We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications. DISCUSSIONS: The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.
OBJECTIVE: The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison. BACKGROUND: PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking. METHODS: The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021. RESULTS: We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications. DISCUSSIONS: The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.