Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS).

Humans Pancreatectomy / methods Pancreatic Fistula / prevention & control Postoperative Complications / prevention & control

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
07 2020
Historique:
received: 05 10 2019
revised: 11 02 2020
accepted: 18 02 2020
pubmed: 7 4 2020
medline: 1 9 2020
entrez: 7 4 2020
Statut: ppublish

Résumé

The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines. Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the level of objective support for each. Studies using the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula including 16 randomized trials were reviewed to generate a series of statements set into 14 domains. There was strong consensus in the following statements: there was no difference in the postoperative pancreatic fistula rate after left pancreatectomy between the handsewn and stapler techniques; a stapling technique could not be used in all cases of left pancreatectomy; the use of an energy-based tissue sealant or a chemical sealant device or combinations of these did not impact the postoperative pancreatic fistula rate; there was no difference in the postoperative pancreatic fistula rate between the open, laparoscopic, or robotic approaches; and there are 1 or more clinically important, patient-related risk factors associated with the postoperative pancreatic fistula rate. There was weak or conditional agreement on the use of prophylactic somatostatin analogs, stents, stump closure, stump anastomosis, and the role of abdominal drains. Areas of strong consensus suggests a change in clinical practice and priority setting. Eight domains with lower agreement will require novel approaches and large multicenter studies to determine future key areas of practice.

Sections du résumé

BACKGROUND
The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines.
METHODS
Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the level of objective support for each.
RESULTS
Studies using the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula including 16 randomized trials were reviewed to generate a series of statements set into 14 domains. There was strong consensus in the following statements: there was no difference in the postoperative pancreatic fistula rate after left pancreatectomy between the handsewn and stapler techniques; a stapling technique could not be used in all cases of left pancreatectomy; the use of an energy-based tissue sealant or a chemical sealant device or combinations of these did not impact the postoperative pancreatic fistula rate; there was no difference in the postoperative pancreatic fistula rate between the open, laparoscopic, or robotic approaches; and there are 1 or more clinically important, patient-related risk factors associated with the postoperative pancreatic fistula rate. There was weak or conditional agreement on the use of prophylactic somatostatin analogs, stents, stump closure, stump anastomosis, and the role of abdominal drains.
CONCLUSION
Areas of strong consensus suggests a change in clinical practice and priority setting. Eight domains with lower agreement will require novel approaches and large multicenter studies to determine future key areas of practice.

Identifiants

DOI: 10.1016/j.surg.2020.02.018 PMID: 32249092
pubmed: 32249092
pii: S0039-6060(20)30103-3
doi: 10.1016/j.surg.2020.02.018
pii:
doi:

Types de publication

Journal Article Practice Guideline Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

72-84

Subventions

Organisme : Department of Health
ID : 08/29/02
Pays : United Kingdom
Organisme : Cancer Research UK
ID : 11883
Pays : United Kingdom
Organisme : Cancer Research UK
ID : 8968
Pays : United Kingdom

Investigateurs

Yi Miao (Y)
Markus W Büchler (MW)
Carlos Fernandez-Del Castillo (C)
John P Neoptolemos (JP)
Christos Dervenis (C)
Paula Ghaneh (P)
Jörg Kleeff (J)
Shailesh V Shrikhande (SV)
Massimo Falconi (M)
Kyoichi Takaori (K)
Masao Tanaka (M)
Tooru Shimosegawa (T)
Yunpeng Peng (Y)
Guangfu Wang (G)
Xumin Huang (X)
Zipeng Lu (Z)

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

Auteurs

Yi Miao (Y)

Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China. Electronic address: miaoyi@njmu.edu.cn.

Zipeng Lu (Z)

Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.

Charles J Yeo (CJ)

Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.

Charles M Vollmer (CM)

Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Carlos Fernandez-Del Castillo (C)

Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Paula Ghaneh (P)

Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.

Christopher M Halloran (CM)

Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.

Jörg Kleeff (J)

Department of Surgery, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.

Thijs de Rooij (T)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Jens Werner (J)

Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians-University, Munich, Germany.

Massimo Falconi (M)

Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy.

Helmut Friess (H)

Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany.

Herbert J Zeh (HJ)

Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Jakob R Izbicki (JR)

Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Jin He (J)

Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.

Johanna Laukkarinen (J)

Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.

Cees H Dejong (CH)

Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

Keith D Lillemoe (KD)

Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Kevin Conlon (K)

Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland.

Kyoichi Takaori (K)

Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Luca Gianotti (L)

School of Medicine and Surgery, Milano - Bicocca University, and Department of Surgery, San Gerardo Hospital, Monza, Italy.

Marc G Besselink (MG)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Marco Del Chiaro (M)

Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.

Marco Montorsi (M)

Humanitas University and Research Hospital IRCCS, Milan, Italy.

Masao Tanaka (M)

Shimonoseki City Hospital, Kyushu University, Shimonoseki, Yamaguchi, Japan.

Maximilian Bockhorn (M)

Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Mustapha Adham (M)

Department of Digestive & HPB Surgery, Hospital Edouard Herriot, HCL, UCBL1, Lyon, France.

Attila Oláh (A)

The Petz Aladar Hospital, Gyor, Hungary.

Roberto Salvia (R)

Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy.

Shailesh V Shrikhande (SV)

Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India.

Thilo Hackert (T)

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.

Tooru Shimosegawa (T)

Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.

Amer H Zureikat (AH)

Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA.

Güralp O Ceyhan (GO)

Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Yunpeng Peng (Y)

Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.

Guangfu Wang (G)

Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.

Xumin Huang (X)

Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.

Christos Dervenis (C)

Medical School, University of Cyprus, Nicosia, Cyprus.

Claudio Bassi (C)

Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy.

John P Neoptolemos (JP)

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.

Markus W Büchler (MW)

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Management of the pancreatic transection plane...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Pancréatectomie › Management of the pancreatic transection plane...
questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Fistule › Fistule digestive › Fistule pancréatique › Management of the pancreatic transection plane...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Management of the pancreatic transection plane...