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The following is a summary of “External Validation of the ISGPS Complexity Grading System for Minimally Invasive Pancreatoduodenectomy: Insights from the IGOMIPS registry,” published in the December 2024 issue of Surgery by Napoli et al.  

Minimally invasive pancreaticoduodenectomy (MIPD) is gaining popularity despite safety concerns. The International Study Group of Pancreatic Surgery (ISGPS) developed a difficulty grading system to match procedure complexity with surgeon expertise, improving patient selection.  

Researchers conducted a retrospective study to validate the ISGPS complexity grading system for MIPD.  

They analyzed data from MIPD cases in the International Group of Minimally Invasive Pancreatoduodenectomy Surgery (IGOMIPS) registry (October 2019–February 2024), using severe postoperative complications as the primary outcome. Logistic regression was used to identify risk factors for complications.  

The results showed 771 MIPD cases, 426 (55.3%) were analyzed. A pancreatic duct size ≤3 mm was the only risk factor for severe complications (OR=2.22, P=0.0001). Most cases (n=255; 59.9%) were classified as grade C complexity, while 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, outcomes were consistent across surgeons and centers. For grade B, outcomes were similar between grade B and grade C centers but superior to grade A centers. In grade C cases, outcomes were comparable between grade A and grade B centers, with improvements observed 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).  

They concluded that the ISGPS complexity grading system effectively predicted outcomes for MIPD, helping to improve patient selection and aligning procedural complexity with the expertise of the surgical team and center.  

Source: journals.lww.com/annalsofsurgery/abstract/9900/external_validation_of_the_isgps_complexity.1148.aspx