Postpancreatectomy Acute Pancreatitis (PPAP) Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS)

被引：101

作者：

Marchegiani, Giovanni ^{[1
]}

Barreto, Savio George ^{[2
]}

Bannone, Elisa ^{[1
]}

Sarr, Michael ^{[3
]}

Vollmer, Charles M. ^{[4
]}

Connor, Saxon ^{[5
]}

Falconi, Massimo ^{[6
]}

Besselink, Marc G. ^{[7
]}

Salvia, Roberto ^{[1
]}

Wolfgang, Christopher L. ^{[8
]}

Zyromski, Nicholas J. ^{[9
]}

Yeo, Charles J. ^{[10
]}

Adham, Mustapha ^{[11
]}

Siriwardena, Ajith K. ^{[12
]}

Takaori, Kyoichi ^{[13
]}

Abu Hilal, Mohammad ^{[14
]}

Loos, Martin ^{[15
]}

Probst, Pascal ^{[15
]}

Hackert, Thilo ^{[15
]}

Strobel, Oliver ^{[15
]}

Busch, Olivier R. C. ^{[7
]}

Lillemoe, Keith D. ^{[16
]}

Miao, Yi ^{[17
]}

Halloran, Christopher M. ^{[18
]}

Werner, Jens ^{[19
]}

Friess, Helmut ^{[20
]}

Izbicki, Jakob R. ^{[21
]}

Bockhorn, Maximillian ^{[22
]}

Vashist, Yogesh K. ^{[23
]}

Conlon, Kevin ^{[24
]}

Passas, Ioannis ^{[25
,26
]}

Gianotti, Luca ^{[27
]}

Del Chiaro, Marco ^{[28
]}

Schulick, Richard D. ^{[29
]}

Montorsi, Marco ^{[30
]}

Olah, Attila ^{[31
]}

Fusai, Giuseppe Kito ^{[32
]}

Serrablo, Alejandro ^{[33
]}

Zerbi, Alessandro ^{[27
]}

Fingerhut, Abe ^{[34
]}

Andersson, Roland ^{[29
]}

Padbury, Robert ^{[2
]}

Dervenis, Christos ^{[24
]}

Neoptolemos, John P. ^{[15
]}

Bassi, Claudio ^{[1
]}

Buchler, Markus W. ^{[15
]}

Shrikhande, Shailesh, V ^{[27
]}

机构：

[1] Verona Univ Hosp, Pancreas Inst, Dept Surg, Verona, Italy

[2] Flinders Med Ctr, Div Surg & Perioperat Med, Adelaide, SA, Australia

[3] Mayo Clin, Dept Gen Surg, Rochester, NY USA

[4] Univ Penn, Perelman Sch Med, Dept Surg, Philadelphia, PA 19104 USA

[5] Christchurch Hosp, Dept Surg, Christchurch, New Zealand

[6] Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Pancreat Surg Unit, Pancreas Translat & Clin Res Ctr, Milan, Italy

[7] Univ Amsterdam, Canc Ctr Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands

[8] NYU Grossman Sch Med, Dept Surg, New York, NY USA

[9] Indiana Univ Sch Med, Indiana Univ Hlth, Indianapolis, IN 46202 USA

[10] Thomas Jefferson Univ, Jefferson Pancreas Biliary & Related Canc Ctr, Philadelphia, PA 19107 USA

[11] Lyon Civil Hosp, Digest Surg Dept, Lyon, France

[12] Manchester Royal Infirm, Manchester, Lancs, England

[13] Kyoto Univ, Dept Surg, Grad Sch Med, Kyoto, Japan

[14] Fdn Poliambulanza, Dept Surg, Brescia, Italy

[15] Heidelberg Univ, Dept Gen Visceral & Transplantat Surg, Heidelberg, Germany

[16] Harvard Med Sch, Massachusetts Gen Hosp, Dept Surg, Boston, MA 02115 USA

[17] Nanjing Med Univ, Affiliated Hosp 1, Pancreas Ctr, Nanjing, Peoples R China

[18] Univ Liverpool, Dept Mol & Clin Canc Med, Liverpool, Merseyside, England

[19] Ludwig Maximilians Univ Munchen, Dept Gen Visceral & Transplantat Surg, Munich, Germany

[20] Tech Univ Munich, Sch Med, Dept Surg, Klinikum Rechts Isar, Munich, Germany

[21] Univ Med Ctr Hamburg Eppendorf, Dept Gen Visceral & Thorac Surg, Hamburg, Germany

[22] Asklepios Harzklin, Goslar, Germany

[23] Univ Dublin, Professorial Surg Unit, Trinity Coll, Dublin, Ireland

[24] AGIA OLGA Hosp, Dept Surg, Athens, Greece

[25] Milano Bicocca Univ, Sch Med & Surg, Monza, Italy

[26] San Gerardo Hosp, Dept Surg, Monza, Italy

[27] Univ Colorado, Div Surg Oncol, Dept Surg, Anschutz Med Campus, Aurora, CO USA

[28] Humanitas Univ & Res Hosp IRCCS, Dept Surg, Milan, Italy

[29] Petz Aladar Hosp, Gyor, Hungary

[30] Royal Free Hosp NHS Fdn Trust, Dept HPB Surg & Liver Transplant, London, England

[31] Miguel Servet Univ Hosp, Dept Surg, Zaragoza, Spain

[32] Univ Graz Hosp, Surg Res Unit, Graz, Austria

[33] Lund Univ, Dept Surg, Clin Sci Lund, Lund, Sweden

[34] Tata Mem Hosp, Dept Gastrointestinal & HPB Surg Oncol, Mumbai, Maharashtra, India

来源：

ANNALS OF SURGERY | 2022年 / 275卷 / 04期

关键词：

definition; International Study Group for Pancreatic Surgery; postpancreatectomy acute pancreatitis; POSTOPERATIVE ACUTE-PANCREATITIS; SERUM AMYLASE; RISK-FACTORS; FISTULA; PANCREATICODUODENECTOMY; HYPERAMYLASEMIA; CLASSIFICATION; RESECTION; COMPLICATIONS; PREDICTORS;

D O I：

10.1097/SLA.0000000000005226

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

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.

引用

页码：663 / 672

页数：10

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