gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

Usefulness of the International Study Group for Pancreatic Fistula (ISPGF) classification system for clinical decision making

Meeting Abstract

  • Florian Gebauer - Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Michael Tachezy - Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Yogesh Vashist - Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Guellue Cataldegirmen - Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Jakob Izbicki - Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Maximilian Bockhorn - Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch596

DOI: 10.3205/11dgch596, URN: urn:nbn:de:0183-11dgch5964

Veröffentlicht: 20. Mai 2011

© 2011 Gebauer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Due to its retrospective character, the classification system of the International Study Group of Pancreatic Fistula (ISGPF) is missing any dynamics as to which patient will develop further fistula-related complications. This study is set out to critically evaluate the usefulness of the ISGPF classification system with respect to clinical decision making.

Materials and methods: Between 1992 - 2009, 1966 patients underwent surgery of the pancreas (either due to carcinoma of the pancreatic head or chronic pancreatitis). The definition of postoperative pancreatic fistula (POPF) was based on the ISPGF consensus. All patient data were entered into a prospective clinical data management system.

Results: 276 patients (14%) developed POPF. ISPGF type A was seen in 65 (24%), type B in 110 (39%) and type C fistula in 101 (37%) patients. One hundred one (37%) patients required reoperation, 175 (63%) patients were managed conservatively. Univariate analysis identified underlying disease, type of operation, high levels of serum amylase and bilirubine on the day of onset to be prognostic parameters for reoperation. Multivariate analysis found elevated serum C-reactive protein as independent factor for increased in-hospital mortality. Solely due to their death, 20 patients had to be classified as type C, even though they suffered only a clinically inapparent type A fistula.

Conclusion: The ISPGF classification system is of no use in clinical decision making, since there is a subgroup of patients that is not adequately pictured by it. To improve clinical decision making as to which patient needs to be treated how, merging of the existing ISGPF classification system with newer clinical data is of mandatory necessity.