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

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

2005 ISGPF definition and grading system for POPF
	Clinical manifestation	Special treatment^a	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 POPF^b	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 POPF^c	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

POPF postoperative pancreatic fistula, ISGPF International Study Group of Pancreatic Fistula, ISGPS International Study Group on Pancreatic Surgery, CT computed tomographic scan
^aPartial (peripheral) or total parenteral nutrition, antibiotics, enteral nutrition, somatostatin analog, and/or minimal invasive drainage
% With or without a drain in situ
^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)
^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

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