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Classification of postoperative pancreatic fistula after left pancreatectomy : International multicentre cohort study

Bonsdorff, Akseli ; Yu, William ; Kirkegård, Jakob ; De Ponthaud, Charles ; Kjeseth, Trond ; Ghorbani, Poya ; Wennerblom, Johanna ; Williamsson, Caroline LU ; Acher, Alexandra W. and Thillai, Manoj , et al. (2025) In BJS Open 9(6).
Abstract

Background Postoperative pancreatic fistula (POPF) is a major complication after left pancreatectomy. The current International Study Group of Pancreatic Surgery classification has limitations, including heterogeneity in morbidity and high interobserver variability. This study aimed to assess POPF-related morbidity after left pancreatectomy and propose a refined classification system. Methods Patients undergoing left pancreatectomy at nine high-volume centres between January 2010 and April 2023 were included. All postoperative treatments and interventions related to POPF were collected. The Comprehensive Complication Index (CCI) was used to assess total cumulative morbidity. The International Study Group of Pancreatic Surgery B POPF was... (More)

Background Postoperative pancreatic fistula (POPF) is a major complication after left pancreatectomy. The current International Study Group of Pancreatic Surgery classification has limitations, including heterogeneity in morbidity and high interobserver variability. This study aimed to assess POPF-related morbidity after left pancreatectomy and propose a refined classification system. Methods Patients undergoing left pancreatectomy at nine high-volume centres between January 2010 and April 2023 were included. All postoperative treatments and interventions related to POPF were collected. The Comprehensive Complication Index (CCI) was used to assess total cumulative morbidity. The International Study Group of Pancreatic Surgery B POPF was subclassified (B1 = prolonged drainage, B2 = pharmacological intervention, B3 = percutaneous intervention, B4 = endoscopic or angiographic intervention). A new POPF grading system was developed by combining subclasses with similar morbidity. Results Among 2284 patients, 497 (21.8%) had B (B1: 48 (2.1%), B2: 135 (5.9%), B3: 175 (7.7%), B4: 99 (4.3%)) or C (40 (1.8%)) POPF. Median (interquartile range) POPF-related CCI was 33.5 (22.6-39.7). A significant overlap existed between B and C POPF in terms of CCI. Median CCI (i.q.r.) increased with the B POPF subclasses (B1-B4), 8.7 (8.7-8.7) - 22.6 (20.9-22.6) - 33.5 (33.5-34.6) - 47.4 (39.7-52.1) (P < 0.001), but no difference between B4 POPF and C POPF was observed (median CCI 47.4 versus 50.2; P = 0.265). The refined POPF grading system consists of grades 0 (including biochemical leak and B1), A (including B2), B (including B3), and C (including B4 and C) reflecting worsening morbidity. Conclusion The current International Study Group of Pancreatic Surgery classification includes highly heterogeneous grade B POPF cases, ranging from minimal to severe morbidity. The refined grading system improves classification and clinical relevance by aligning POPF severity with morbidity and short-term outcomes.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BJS Open
volume
9
issue
6
article number
zraf149
publisher
Wiley
external identifiers
  • pmid:41335124
  • scopus:105023673864
ISSN
2474-9842
DOI
10.1093/bjsopen/zraf149
language
English
LU publication?
yes
id
9d7e6ac5-6fdf-44eb-90ab-5b7668f1a2ca
date added to LUP
2026-01-14 11:19:30
date last changed
2026-01-14 11:20:22
@article{9d7e6ac5-6fdf-44eb-90ab-5b7668f1a2ca,
  abstract     = {{<p>Background Postoperative pancreatic fistula (POPF) is a major complication after left pancreatectomy. The current International Study Group of Pancreatic Surgery classification has limitations, including heterogeneity in morbidity and high interobserver variability. This study aimed to assess POPF-related morbidity after left pancreatectomy and propose a refined classification system. Methods Patients undergoing left pancreatectomy at nine high-volume centres between January 2010 and April 2023 were included. All postoperative treatments and interventions related to POPF were collected. The Comprehensive Complication Index (CCI) was used to assess total cumulative morbidity. The International Study Group of Pancreatic Surgery B POPF was subclassified (B1 = prolonged drainage, B2 = pharmacological intervention, B3 = percutaneous intervention, B4 = endoscopic or angiographic intervention). A new POPF grading system was developed by combining subclasses with similar morbidity. Results Among 2284 patients, 497 (21.8%) had B (B1: 48 (2.1%), B2: 135 (5.9%), B3: 175 (7.7%), B4: 99 (4.3%)) or C (40 (1.8%)) POPF. Median (interquartile range) POPF-related CCI was 33.5 (22.6-39.7). A significant overlap existed between B and C POPF in terms of CCI. Median CCI (i.q.r.) increased with the B POPF subclasses (B1-B4), 8.7 (8.7-8.7) - 22.6 (20.9-22.6) - 33.5 (33.5-34.6) - 47.4 (39.7-52.1) (P &lt; 0.001), but no difference between B4 POPF and C POPF was observed (median CCI 47.4 versus 50.2; P = 0.265). The refined POPF grading system consists of grades 0 (including biochemical leak and B1), A (including B2), B (including B3), and C (including B4 and C) reflecting worsening morbidity. Conclusion The current International Study Group of Pancreatic Surgery classification includes highly heterogeneous grade B POPF cases, ranging from minimal to severe morbidity. The refined grading system improves classification and clinical relevance by aligning POPF severity with morbidity and short-term outcomes.</p>}},
  author       = {{Bonsdorff, Akseli and Yu, William and Kirkegård, Jakob and De Ponthaud, Charles and Kjeseth, Trond and Ghorbani, Poya and Wennerblom, Johanna and Williamsson, Caroline and Acher, Alexandra W. and Thillai, Manoj and Tarvainen, Timo and Uutela, Aki and Sirén, Jukka and Kokkola, Arto and Kleive, Dyre and Sahakyan, Mushegh and Hagen, Rolf E. and Lund, Andrea and Fugleberg Nielsen, Mette and Fristedt, Richard and Biörserud, Christina and Bratlie, Svein Olav and Tingstedt, Bobby and Labori, Knut J. and Gaujoux, Sébastien and Wigmore, Stephen J. and Hallet, Julie and Sparrelid, Ernesto and Sallinen, Ville}},
  issn         = {{2474-9842}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{Wiley}},
  series       = {{BJS Open}},
  title        = {{Classification of postoperative pancreatic fistula after left pancreatectomy : International multicentre cohort study}},
  url          = {{http://dx.doi.org/10.1093/bjsopen/zraf149}},
  doi          = {{10.1093/bjsopen/zraf149}},
  volume       = {{9}},
  year         = {{2025}},
}