ArticleAnnals of surgery2026
External Validation of the International Study Group for Pancreatic Surgery Complexity Grading System for Minimally Invasive Pancreatoduodenectomy: Insights From the IGOMIPS Registry.
Article in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Pancreatic ductal adenocarcinoma and pancreatic surgery in the 21st century: triumphs, turning points, and unresolved challenges.Updates in surgery · 2026Review
- Development and frontier trends of pancreaticojejunostomy over the past 26 years: bibliometric and visual analysis.Gland surgery · 2026Article
- When should the robot step aside?-conversion in robotic distal pancreatectomy: lessons from an international multicenter study.Gland surgery · 2026Article
- The APROVE (Anti-coagulation/Platelet Treatment in Pancreatic Resections Involving Vascular Reconstruction) Study: Results from a Worldwide Survey.Annals of surgical oncology · 2025Article
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30 authors.
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Abstract
objectiveTo validate the International Study Group for Pancreatic Surgery (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 (odds ratio = 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.
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