Clinical impact of the updated international postoperative pancreatic fistula definition in distal pancreatectomy

Background: Postoperative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy. The International Study Group on Pancreatic Surgery definition of POPF is used worldwide. Recently, an update of the definition was published. The aim of this study was to determine the clinical impact of the update.Methods: An international retrospective validation study, including patients who underwent DP (2005-2016) in 5 centers was performed. Distribution of complications amongst POPF grades were compared for the old and updated definition.Results: In total, 1089 patients were included. The incidence of POPF decreased with the updated definition from 47% to 24% (P < 0.01), largely because a downgrade of grade A and grade B into biochemical leak. Comparable morbidity was seen in the old and updated 'no POPF group' (Clavien - Dindo 3 5% vs. 6% P = 0.320 and hospital stay (7 vs. 7 days P = 0.301). The change in definition of POPF grade B resulted in more Clavien - Dindo 3 (38% vs. 51%) P < 0.01) and longer hospital stay (9 [9 - 13] vs. 9 days [7 - 15] P < 0.01) in the updated 'grade B group'.Conclusion: Applying the updated POPF definition showed improved discrimination between grades and should therefore be used to report POPF after DP.