胰腺手术国际研究小组4级(A-D)危险分级标准，即术后胰腺漏管分级B/C是基于胰腺组织质地和胰管大小：A(非软质地和胰管>3毫米)，B(非软质地和胰管≤3毫米)，C(软质地和胰管>3毫米)和D(软质地和胰管≤3毫米)。本研究旨在验证胰十二指肠切除术后胰腺漏管的国际研究小组危险分级标准。通过荷兰全国强制性胰腺癌登记数据库，连续收纳了所有适应症(2014-2021年)的胰十二指肠切除术后的患者。根据国际胰腺手术研究小组2016年的定义，计算每个危险类别的术后胰腺漏管分级B/C的比率。使用接收器操作曲线下面积(判别能力)和校准图对模型性能进行评估。总体而言，共有3900名患者被纳入危险类别：A(n=1046)、B(n=498)、C(n=963)和D(n=1393)，相应的术后胰腺漏管分级B/C比率分别为3.8%、12.2%、15.6%和29.6%。每个类别的院内死亡率分别为1.3%、3.4%、2.9%和4.1%，P=0.001。B和C危险类别之间的术后胰腺漏管发病率没有差异(12.2%vs 15.6%，P=0.101)。当将分级系统简化为三级分级系统(基于0、1和2个危险因素)，判别能力没有显著差异(接收器操作曲线下面积0.697 vs 接收器操作曲线下面积0.701，P=0.077)。本研究验证了胰腺十二指肠切除术后胰腺漏管的国际手术研究小组4级危险分级标准，证实其预测价值。然而，由于中等危险类别没有额外的预测价值，因此建议使用简化的三级分级系统，并应在未来的前瞻性研究中进行验证。版权所有©2023 Elsevier Inc.。保留所有权利。

The International Study Group of Pancreatic Surgery 4-tier (ie, A-D) risk classification for postoperative pancreatic fistula grade B/C is based on pancreatic texture and pancreatic duct size: A (not-soft texture and pancreatic duct >3 mm), B (not-soft texture and pancreatic duct ≤3 mm), C (soft texture and pancreatic duct >3 mm), and D (soft texture and pancreatic duct ≤3 mm). This study aimed to validate the International Study Group of Pancreatic Surgery risk classification for postoperative pancreatic fistula after pancreatoduodenectomy.Consecutive patients after pancreatoduodenectomy for all indications (2014-2021) were included from the nationwide, mandatory Dutch Pancreatic Cancer Audit. The rate of postoperative pancreatic fistula grade B/C (according to the International Study Group of Pancreatic Surgery 2016 definition) was calculated per risk category. Model performance was assessed using the area under the receiver operating curve (discrimination) and calibration plots.Overall, 3,900 patients were included in risk categories: A (n = 1,046), B (n = 498), C (n = 963), and D (n = 1,393) with corresponding postoperative pancreatic fistula grade B/C rates of 3.8%, 12.2%, 15.6%, and 29.6%. Per category, the in-hospital mortality rates were 1.3%, 3.4%, 2.9%, and 4.1%, P = .001. There was no difference in the rate of postoperative pancreatic fistula between risk categories B and C (12.2% vs 15.6%, P = .101). When simplifying the classification system to a 3-tier classification system (based on 0, 1, and 2 risk factors), the discrimination was not significantly different (area under the receiver operating curve 0.697 vs area under the receiver operating curve 0.701, P = .077).This validation of the 4-tier International Study Group of Pancreatic Surgery risk classification for postoperative pancreatic fistula after pancreatoduodenectomy confirmed its predictive value. However, as the 2 middle risk categories provide no added predictive value, a simplified 3-tier classification with comparable predictive value is proposed and should be validated in future prospective studies.Copyright © 2023 Elsevier Inc. All rights reserved.