Complexity and Experience Grading to Guide Patient Selection for Minimally-invasive Pancreatoduodenectomy: An ISGPS Consensus.

Autor:	Barreto SG; Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.; College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia., Strobel O; Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria., Salvia R; Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy., Marchegiani G; Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy., Wolfgang CL; Department of Surgery, NYU Grossman School of Medicine, New York, NY., Werner J; Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich, Munich, Germany., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Boston, MA., Abu Hilal M; Department of Surgery, Fondazione Poliambulanza, Brescia, Italy., Boggi U; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Butturini G; Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy., Falconi M; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy., Fernandez-Del Castillo C; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Friess H; Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany., Fusai GK; HPB & Liver Transplant Unit, Royal Free Hospital, London - UK., Halloran CM; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom., Hogg M; Department of HPB Surgery, University of Chicago - Northshore, Chicago, Illinois, United States of America., Jang JY; Department of General Surgery, Seoul National University College of Medicine, Seoul, Korea., Kleeff J; Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Germany., Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Miao Y; Pancreas Center, The First Affiliated Hospital of Nanjing Medical University.; Pancreas Institute, Nanjing Medical University.; Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University., Nagakawa Y; Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, Japan., Nakamura M; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Probst P; Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland., Satoi S; Department of Surgery, Kansai Medical University, Osaka, Japan.; Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Siriwardena AK; Department of HPB Surgery, Manchester Royal Infirmary, Manchester, The United Kingdom., Vollmer CM; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA., Zureikat A; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Zyromski NJ; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA., Asbun HJ; Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA., Dervenis C; Department of Surgery, AGIA OLGA Hospital, Athens, Greece., Neoptolemos JP; Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.; Botton-Champalimaud Pancreatic Cancer Centre, Champalimaud Foundation, Lisbon, Portugal., Büchler MW; Botton-Champalimaud Pancreatic Cancer Centre, Champalimaud Foundation, Lisbon, Portugal., Hackert T; Dept. Of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, the Netherlands., Shrikhande SV; Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jul 22. Date of Electronic Publication: 2024 Jul 22.
DOI:	10.1097/SLA.0000000000006454
Abstrakt:	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. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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