{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:40:46Z","timestamp":1789656046576,"version":"4.0.1"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010711","name":"Cancer Foundation Finland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015738","name":"Mary & Georg C. Ehrnroot Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008723","name":"The Finnish Medical Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Helsinki University Hospital Research Grants"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative pancreatic fistula (POPF) is a major complication after left pancreatectomy. The current International Study Group of Pancreatic Surgery classification has limitations, including heterogeneity in morbidity and high interobserver variability. This study aimed to assess POPF-related morbidity after left pancreatectomy and propose a refined classification system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients undergoing left pancreatectomy at nine high-volume centres between January 2010 and April 2023 were included. All postoperative treatments and interventions related to POPF were collected. The Comprehensive Complication Index (CCI) was used to assess total cumulative morbidity. The International Study Group of Pancreatic Surgery B POPF was subclassified (B1 = prolonged drainage, B2 = pharmacological intervention, B3 = percutaneous intervention, B4 = endoscopic or angiographic intervention). A new POPF grading system was developed by combining subclasses with similar morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2284 patients, 497 (21.8%) had B (B1: 48 (2.1%), B2: 135 (5.9%), B3: 175 (7.7%), B4: 99 (4.3%)) or C (40 (1.8%)) POPF. Median (interquartile range) POPF-related CCI was 33.5 (22.6\u201339.7). A significant overlap existed between B and C POPF in terms of CCI. Median CCI (i.q.r.) increased with the B POPF subclasses (B1\u2013B4), 8.7 (8.7-8.7) \u2013 22.6 (20.9-22.6) \u2013 33.5 (33.5-34.6) \u2013 47.4 (39.7-52.1) (P &amp;lt; 0.001), but no difference between B4 POPF and C POPF was observed (median CCI 47.4 versus 50.2; P = 0.265). The refined POPF grading system consists of grades 0 (including biochemical leak and B1), A (including B2), B (including B3), and C (including B4 and C) reflecting worsening morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The current International Study Group of Pancreatic Surgery classification includes highly heterogeneous grade B POPF cases, ranging from minimal to severe morbidity. The refined grading system improves classification and clinical relevance by aligning POPF severity with morbidity and short-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf149","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:27:48Z","timestamp":1761222468000},"source":"Crossref","is-referenced-by-count":3,"title":["Classification of postoperative pancreatic fistula after left pancreatectomy: international multicentre cohort study"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2096-6131","authenticated-orcid":false,"given":"Akseli","family":"Bonsdorff","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6994-0637","authenticated-orcid":false,"given":"Jakob","family":"Kirkeg\u00e5rd","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aarhus University Hospital, HPB Section and Institute for Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6011-7663","authenticated-orcid":false,"given":"Charles","family":"de Ponthaud","sequence":"additional","affiliation":[{"name":"Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Sorbonne Universit\u00e9 Paris , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trond","family":"Kjeseth","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Department of Clinical Medicine, University of Bergen , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poya","family":"Ghorbani","sequence":"additional","affiliation":[{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2757-7489","authenticated-orcid":false,"given":"Johanna","family":"Wennerblom","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Williamsson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lund University, Sk\u00e5ne University Hospital at Lund , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra W","family":"Acher","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Toronto and Sunnybrook Health Sciences Centre , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Thillai","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Pancreatic Unit & Edinburgh Transplant Unit, University of Edinburgh, Royal Infirmary , Edinburgh ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Tarvainen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1324-5894","authenticated-orcid":false,"given":"Aki","family":"Uutela","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Pancreatic Unit & Edinburgh Transplant Unit, University of Edinburgh, Royal Infirmary , Edinburgh ,","place":["UK"]},{"name":"Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka","family":"Sir\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arto","family":"Kokkola","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyre","family":"Kleive","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4815-7694","authenticated-orcid":false,"given":"Mushegh","family":"Sahakyan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vestre Viken Hospital Trust, Ringerike Hospital , H\u00f8nefoss ,","place":["Norway"]},{"name":"The Intervention Centre, Oslo University Hospital, Rikshospitalet , Oslo ,","place":["Norway"]},{"name":"Department of Surgery N1, Yerevan State Medical University , Yerevan ,","place":["Armenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9389-4140","authenticated-orcid":false,"given":"Rolf E","family":"Hagen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Vestfold Hospital Trust , T\u00f8nsberg ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lund","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aarhus University Hospital, HPB Section and Institute for Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette","family":"Fugleberg Nielsen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aarhus University Hospital, HPB Section and Institute for Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Fristedt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lund University, Sk\u00e5ne University Hospital at Lund , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Bi\u00f6rserud","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svein Olav","family":"Bratlie","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5940-8276","authenticated-orcid":false,"given":"Bobby","family":"Tingstedt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lund University, Sk\u00e5ne University Hospital at Lund , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut J","family":"Labori","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1072-7639","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Gaujoux","sequence":"additional","affiliation":[{"name":"Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Sorbonne Universit\u00e9 Paris , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen 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