CLASSIFICATION AND GRADING SYSTEMS OF POSTOPERATIVE PANCREATIC FISTULA (POP)
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Abstract:
Postoperative pancreatic fistula (POPF) remains the most problematic complication of pancreatic surgery, occurring in 10–30% of resections and accounting for up to 60% of severe morbidity and two-thirds of total treatment costs. The 2005 ISGPF classification introduced a three-tier grading system (A, B, C), but Grade A—lacking clinical impact—artificially inflated fistula rates and reduced inter-rater reliability. The 2016 ISGPS revision reclassified Grade A as “biochemical leak,” redefining Grades B and C using objective thresholds (drainage >3 weeks, need for intervention, organ failure, reoperation, or death). This review compares the 2005 and 2016 definitions across 37,259 patients from 38 centers. The 2016 update halved the crude POPF rate (28.0% → 14.1%) without changing the incidence of clinically relevant POPF (11.0%).
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