TY - JOUR
T1 - Complexity and Experience Grading to Guide Patient Selection for Minimally-invasive Pancreatoduodenectomy
T2 - An ISGPS Consensus
AU - Barreto, S. George
AU - Strobel, Oliver
AU - Salvia, Roberto
AU - Marchegiani, Giovanni
AU - Wolfgang, Christopher L.
AU - Werner, Jens
AU - Ferrone, Cristina R.
AU - Abu Hilal, Mohammed
AU - Boggi, Ugo
AU - Butturini, Giovanni
AU - Falconi, Massimo
AU - Fernandez-Del Castillo, Carlos
AU - Friess, Helmut
AU - Fusai, Giuseppe K.
AU - Halloran, Christopher M.
AU - Hogg, Melissa
AU - Jang, Jin Young
AU - Kleeff, Jorg
AU - Lillemoe, Keith D.
AU - Miao, Yi
AU - Nagakawa, Yuichi
AU - Nakamura, Masafumi
AU - Probst, Pascal
AU - Satoi, Sohei
AU - Siriwardena, Ajith K.
AU - Vollmer, Charles M.
AU - Zureikat, Amer
AU - Zyromski, Nicholas J.
AU - Asbun, Horacio J.
AU - Dervenis, Christos
AU - Neoptolemos, John P.
AU - Büchler, Markus W.
AU - Hackert, Thilo
AU - Besselink, Marc G.
AU - Shrikhande, Shailesh V.
AU - for the International Study Group for Pancreatic Surgery
PY - 2024/7/22
Y1 - 2024/7/22
N2 - Objective: The ISGPS aims to develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally-invasive pancreatoduodenectomy (MIPD). Background: Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis towards appropriate patient selection according to adequate surgeon and center experience.Methods: The ISGPS developed a complexity and experience grading system to guide patient selection for MIPD based on an evidence-based review and a series of discussions. Results: The ISGPS complexity and experience grading system for MIPD is subclassified into patient-related risk factors and provider experience-related variables. The patient-related risk factors include anatomical (main pancreatic and common bile duct diameters), tumor-specific (vascular contact), and conditional (obesity and previous complicated upper abdominal surgery/disease) factors, all incorporated in an A-B-C classification, graded as no, a single, and multiple risk factors. The surgeon and center experience-related variables include surgeon total MIPD experience (cut-offs 40 and 80) and center annual MIPD volume (cut-offs 10 and 30), all also incorporated in an A-B-C classification. Conclusion: This ISGPS complexity and experience grading system for robotic and laparoscopic MIPD may enable surgeons to optimally select patients after duly considering specific risk factors known to influence the complexity of the procedure. This grading system will likely allow for a thoughtful and stepwise implementation of MIPD and facilitate a fair comparison of outcome between centers and countries.
AB - Objective: The ISGPS aims to develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally-invasive pancreatoduodenectomy (MIPD). Background: Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis towards appropriate patient selection according to adequate surgeon and center experience.Methods: The ISGPS developed a complexity and experience grading system to guide patient selection for MIPD based on an evidence-based review and a series of discussions. Results: The ISGPS complexity and experience grading system for MIPD is subclassified into patient-related risk factors and provider experience-related variables. The patient-related risk factors include anatomical (main pancreatic and common bile duct diameters), tumor-specific (vascular contact), and conditional (obesity and previous complicated upper abdominal surgery/disease) factors, all incorporated in an A-B-C classification, graded as no, a single, and multiple risk factors. The surgeon and center experience-related variables include surgeon total MIPD experience (cut-offs 40 and 80) and center annual MIPD volume (cut-offs 10 and 30), all also incorporated in an A-B-C classification. Conclusion: This ISGPS complexity and experience grading system for robotic and laparoscopic MIPD may enable surgeons to optimally select patients after duly considering specific risk factors known to influence the complexity of the procedure. This grading system will likely allow for a thoughtful and stepwise implementation of MIPD and facilitate a fair comparison of outcome between centers and countries.
KW - outcomes
KW - pancreaticoduodenectomy
KW - quality
UR - http://www.scopus.com/inward/record.url?scp=85199552587&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000006454
DO - 10.1097/SLA.0000000000006454
M3 - Review article
C2 - 39034920
AN - SCOPUS:85199552587
SN - 0003-4932
JO - Annals of surgery
JF - Annals of surgery
ER -
