Post-Total-Pancreatectomy-Hemorrhage (PTPH) - approaching a new definition

Area of Science:

• Surgical Oncology
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Postoperative bleeding is a significant concern in pancreatic surgery.
• Current classifications, like the International Study Group for Pancreatic Surgery (ISGPS), may not fully address bleeding after total pancreatectomy.
• Specific bleeding causes related to pancreatic fistulas are absent post-total pancreatectomy.

Purpose of the Study:

• To investigate the sources of postoperative bleeding following total pancreatectomy.
• To develop and propose a novel classification system for hemorrhage after total pancreatectomy, termed Post-Total Pancreatectomy Hemorrhage (PTPH).

Main Methods:

• A retrospective review of 195 patients undergoing total pancreatectomy.
• Assessment of baseline characteristics, comorbidities, intraoperative findings, coagulation profiles, and postoperative outcomes.
• Critical evaluation of the ISGPS classification's applicability and development of the PTPH classification with subgroups and a severity index.

Main Results:

• Thirty-five patients (17.9%) experienced hemorrhagic complications.
• The study identified distinct bleeding sources: erosion, surgical, gastrointestinal, and diffuse.
• Timely onset of bleeding and the developed severity index showed significant correlation with the bleeding source.

Conclusions:

• The existing ISGPS classification is insufficient for characterizing bleeding after total pancreatectomy.
• The proposed PTPH classification provides a more granular, clinically relevant framework for managing post-total pancreatectomy hemorrhage.
• The PTPH classification includes clearly defined subgroups based on bleeding source and incorporates an innovative severity index.