微创胰十二指肠切除术ISGPS复杂性分级系统的外部验证：来自IGOMIPS注册研究的见解

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

作者信息

Napoli Niccolò, Donisi Greta, Kauffmann Emanuele F, Ginesini Michael, Abu Hilal Mohammad, Baiocchi Gianluca, Bracale Umberto, Brolese Alberto, Butturini Giovanni, Coppola Roberto, Coratti Andrea, Valle Raffaele Dalla, Di Benedetto Fabrizio, Ercolani Giorgio, Ferrari Giovanni, Garulli Gianluca, Jovine Elio, Mazzola Michele, Memeo Riccardo, Molino Carlo, Moraldi Luca, Morelli Luca, Salvia Roberto, Tebala Giovanni D, Tondolo Vincenzo, Troisi Roberto Ivan, Viola Massimo Giuseppe, Vivarelli Marco, Zerbi Alessandro, Boggi Ugo

机构信息

Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

出版信息

Ann Surg. 2024 Dec 18. doi: 10.1097/SLA.0000000000006612.

DOI:10.1097/SLA.0000000000006612

PMID:39692008

Abstract

OBJECTIVE

To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD).

BACKGROUND

Although 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.

METHODS

Data 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.

RESULTS

Of 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).

CONCLUSIONS

The ISGPS complexity grading system effectively predicted MIPD outcomes, supporting better patient selection and alignment of complexity with surgical expertise.

摘要

目的

验证国际胰腺外科研究组（ISGPS）的微创胰十二指肠切除术（MIPD）复杂性分级系统。

背景

尽管对患者安全的担忧依然存在，但MIPD正日益普及。ISGPS最近推出了一种难度分级系统，通过使手术复杂性与外科医生和中心的专业知识相匹配来改善患者选择。

方法

分析了国际微创胰十二指肠切除术登记处（2019年10月至2024年2月）报告的MIPD病例数据，将严重术后并发症作为主要结局。采用逻辑回归分析确定并发症的危险因素。

结果

771例MIPD病例中，426例（55.3%）进行了分析。胰管直径≤3 mm是严重并发症的唯一显著危险因素（OR=2.22，P=0.0001）。大多数病例（n=255；59.9%）被归类为C级复杂性，而22例（5.1%）被归类为A级。严重术后并发症随复杂性增加而增加（A级，31.8%；B级，36.3%；C级，48.6%；P=0.0091）。对于A级复杂性，不同外科医生和中心的结果一致。B级中心的B级结果与C级中心相似，但优于A级中心。在C级病例中，A级和B级中心的结果相当，C级中心有改善。A级ISGPS经验与计划手术和实际手术之间的不匹配密切相关（A级，15.0%；B级，3.0%；C级，3.1%；P<0.0001），包括全胰切除术（A级，11.5%；B级，1.2%；C级，3.1%；P=0.0005）。