TY - JOUR
T1 - Postpancreatectomy Acute Pancreatitis (PPAP)
T2 - Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)
AU - Marchegiani, Giovanni
AU - Barreto, Savio George
AU - Bannone, Elisa
AU - Sarr, Michael
AU - Vollmer, Charles M.
AU - Connor, Saxon
AU - Falconi, Massimo
AU - Besselink, Marc G.
AU - Salvia, Roberto
AU - Wolfgang, Christopher L.
AU - Zyromski, Nicholas J.
AU - Yeo, Charles J.
AU - Adham, Mustapha
AU - Siriwardena, Ajith K.
AU - Takaori, Kyoichi
AU - Hilal, Mohammad Abu
AU - Loos, Martin
AU - Probst, Pascal
AU - Hackert, Thilo
AU - Strobel, Oliver
AU - Busch, Olivier R. C.
AU - Lillemoe, Keith D.
AU - Miao, Yi
AU - Halloran, Christopher M.
AU - Werner, Jens
AU - Friess, Helmut
AU - Izbicki, Jakob R.
AU - Bockhorn, Maximillian
AU - Vashist, Yogesh K.
AU - Conlon, Kevin
AU - Passas, Ioannis
AU - Gianotti, Luca
AU - del Chiaro, Marco
AU - Schulick, Richard D.
AU - Montorsi, Marco
AU - Oláh, Attila
AU - Fusai, Giuseppe Kito
AU - Serrablo, Alejandro
AU - Zerbi, Alessandro
AU - Fingerhut, Abe
AU - Andersson, Roland
AU - Padbury, Robert
AU - Dervenis, Christos
AU - Neoptolemos, John P.
AU - Bassi, Claudio
AU - Büchler, Markus W.
AU - Shrikhande, Shailesh V.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - 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.
AB - 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.
KW - International Study Group for Pancreatic Surgery
KW - definition
KW - postpancreatectomy acute pancreatitis
UR - https://www.scopus.com/pages/publications/85122945187
U2 - 10.1097/SLA.0000000000005226
DO - 10.1097/SLA.0000000000005226
M3 - Review article
C2 - 34596077
SN - 0003-4932
VL - 275
SP - 663
EP - 672
JO - Annals of Surgery
JF - Annals of Surgery
IS - 4
ER -