Risk factors and prevention of pancreatic fistula after laparoscopic gastrectomy for gastric cancer

Table 3 Revised 2016 International Study Group of Pancreatic Surgery classification and grading of postoperative pancreatic fistula: Checklist for clinical use[55]

Event	BL	Grade B POPF1	Grade C POPF1
Increased amylase activity > 3 times upper limit institutional normal serum value	Yes	Yes	Yes
Persisting peripancreatic drainage > 3 weeks	No	Yes	Yes
Clinically relevant change in management of POPF2	No	Yes	Yes
POPF percutaneous or endoscopic specific interventions for collections	No	Yes	Yes
Angiographic procedures for POPF related bleeding	No	Yes	Yes
Reoperation for POPF	No	No	Yes
Signs of infection related to POPF	No	Yes, without organ failure	Yes, with organ failure
POPF related organ failure3	No	No	Yes
POPF-related death	No	No	Yes

¹A clinically relevant postoperative pancreatic fistula is defined as a drain output of any measurable volume of fluid with an amylase level greater than 3 times the upper Institutional normal serum amylase level, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula.

²Suggests prolongation of hospital or intensive care unit stay, including use of therapeutic agents specifically employed for fistula management or its consequences (of these: somatostatin analogs, total parenteral nutrition/total enteral nutrition, blood product transfusion, or other medications).

³Postoperative organ failure is defined as the need for re-intubation, hemodialysis, and/or inotropic agents > 24 h for respiratory, renal, or cardiac insufficiency, respectively.

BL: Biochemical leak; POPF: Postoperative pancreatic fistula.