Usefulness of the International Study Group for Pancreatic Fistula (ISGPF) Classification for Clinical Decision Making
Florian Gebauer, Michael Tachezy, Yogesh K. Vashist, Guellue Cataldegirmen, Jakob R. Izbicki, Maximilian Bockhorn*
General- Visceral and Thoracic Surgery, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
Background:Due to its retrospective character, the classification system of the International Study Group of Pancreatic Fistula (ISGPF) lacks any prognostic capacity regarding which patients will develop further fistula-related complications. This study aimed to critically evaluate the usefulness of the ISGPF classification system with respect to clinical decision making.Methods:Between 1992 and 2009, 1966 patients underwent surgery of the pancreas. The definition of postoperative pancreatic fistula (POPF) was based on the ISGPF consensus. All patient data were entered into a prospective clinical data management system.Results: 276 patients (14%) developed POPF. ISGPF type A fistula was seen in 65 patients (24%), type B in 110 (39%) and type C in 101 (37%). While 101 patients (37%) required reoperation, 175 (63%) were managed conservatively. Univariate analysis identified underlying disease, type of operation, and high levels of serum amylase or bilirubin on the day of onset to be prognostic parameters for reoperation. Multivariate analysis found elevated serum C-reactive protein to be an independent factor for increased in-hospital mortality. Solely due to their death, 20 patients had to be classified as having a type C fistula, even though they suffered only 'only type A or B.Conclusions: The ISGPF classification system is of no use in clinical decision making, since it does not adequately describe a large subgroup of patients. To improve clinical decision making about management of patients, it is crucial that the existing ISGPF classification system is merged with newer clinical data.
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