• Annals of surgery · Dec 2024

    External Validation of the ISGPS Complexity Grading System for Minimally Invasive Pancreatoduodenectomy: Insights from the IGOMIPS registry.

    • Niccolò Napoli, Greta Donisi, Emanuele F Kauffmann, Michael Ginesini, Mohammad Abu Hilal, Gianluca Baiocchi, Umberto Bracale, Alberto Brolese, Giovanni Butturini, Roberto Coppola, Andrea Coratti, ValleRaffaele DallaRDProgramma di Chirurgia Oncologica ad indirizzo epato-bilio-pancreatico, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy., Fabrizio Di Benedetto, Giorgio Ercolani, Giovanni Ferrari, Gianluca Garulli, Elio Jovine, Michele Mazzola, Riccardo Memeo, Carlo Molino, Luca Moraldi, Luca Morelli, Roberto Salvia, Giovanni D Tebala, Vincenzo Tondolo, Roberto Ivan Troisi, Massimo Giuseppe Viola, Marco Vivarelli, Alessandro Zerbi, and Ugo Boggi.
    • Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
    • Ann. Surg. 2024 Dec 18.

    ObjectiveTo validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD).BackgroundAlthough concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise.MethodsData from MIPD cases reported in the IGOMIPS registry (October 2019-February 2024) were analyzed, with severe postoperative complications as the primary outcome. Logistic regression was used to identify risk factors for complications.ResultsOf the 771 MIPD cases, 426 (55.3%) were analyzed. A pancreatic duct size ≤3 mm was the only significant risk factor for severe complications (OR=2.22, P=0.0001). Most cases (n=255; 59.9%) were classified as grade C complexity, whereas 22 (5.1%) were classified as grade A. Severe postoperative complications increased with complexity (grade A, 31.8%; grade B, 36.3%; grade C, 48.6%; P=0.0091). For grade A complexity, the outcomes were consistent across surgeons and centers. Grade B outcomes were similar between grade B and C centers but superior to grade A centers. In grade C cases, outcomes were comparable between grade A and B centers, with improvements at grade C centers. Grade A ISGPS experience correlated strongly with mismatches between planned and performed procedures (grade A, 15.0%; grade B, 3.0%; grade C, 3.1%; P<0.0001), including total pancreatectomy (grade A, 11.5%; grade B, 1.2%; grade C, 3.1%; P=0.0005).ConclusionsThe ISGPS complexity grading system effectively predicted MIPD outcomes, supporting better patient selection and alignment of complexity with surgical expertise.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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