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Table 1 Comparison of definition and grading system for POPF between 2005 and 2016

From: Establishment of risk prediction model of postoperative pancreatic fistula after pancreatoduodenectomy: 2016 edition of definition and grading system of pancreatic fistula: a single center experience with 223 cases

2005 ISGPF definition and grading system for POPF
  Clinical manifestation Special treatmenta Ultrasound or CT Persistent drainage > 3 weeks% Secondary operation Death related to pancreatic fistula Infection signs Sepsis Readmission
Grade A Good No Negative No No No No No No
Grade B Usually good Yes/no Negative/positive Usually conducted No No Yes No Yes/no
Grade C Sickly appearance/bad Yes Positive Yes Yes May be Yes Yes Yes/no
2016 ISGPS definition and grading system for POPF
  Increased amylase activity > 3 times upper limit institutional normal serum value Persisting peripancreatic drainage
> 3 weeks
Clinically relevant change in management of POPFb POPF percutaneous or endoscopic specific interventions for collections Angiographic procedures for POPF related bleeding Reoperation for POPF Infection signs related to POPF Organ failure related to POPFc Death related to POPF
Biochemical leakage Yes No No No No No No No No
Grade B Yes Yes Yes Yes Yes No Yes (no organ failure) No No
Grade C Yes Yes Yes Yes Yes Yes Yes Yes Yes
  1. POPF postoperative pancreatic fistula, ISGPF International Study Group of Pancreatic Fistula, ISGPS International Study Group on Pancreatic Surgery, CT computed tomographic scan
  2. aPartial (peripheral) or total parenteral nutrition, antibiotics, enteral nutrition, somatostatin analog, and/or minimal invasive drainage
  3. % With or without a drain in situ
  4. bProlongation of hospital or ICU stay includes use of therapeutic agents specifically employed for fistula management or its consequences (of these: somatostatin analogs, TPN/TEN, blood product transfusion, or other medications)
  5. cPostoperative organ failure is defined as the need for re-intubation, hemodialysis, and/or inotropic agents > 24 h for respiratory, renal, or cardiac insufficiency, respectively