REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer.

Journal

Annals of surgery

ISSN: 1528-1140

Titre abrégé: Ann Surg

Pays: United States

ID NLM: 0372354

Informations de publication

Date de publication:
26 Feb 2024

Historique:

medline: 26 2 2024

pubmed: 26 2 2024

entrez: 26 2 2024

Statut: aheadofprint

Résumé

The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population (https://rediscover.unipi.it/). The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.

Sections du résumé

OBJECTIVE OBJECTIVE

SUMMARY BACKGROUND DATA BACKGROUND

Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.

METHODS METHODS

The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.

RESULTS RESULTS

Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population (https://rediscover.unipi.it/).

CONCLUSIONS CONCLUSIONS

The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.

Identifiants

DOI: 10.1097/SLA.0000000000006248 PMID: 38407228

pubmed: 38407228

doi: 10.1097/SLA.0000000000006248

pii: 00000658-990000000-00795

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

Piero Boraschi (P)

Daniela Campani (D)

Carla Cappelli (C)

Roberto Cioni (R)

Massimo Dominici (M)

Irene Esposito (I)

Maria A Gambacorta (MA)

Emanuele Marciano (E)

Gianluca Masi (G)

Alessio Morganti (A)

Massimiliano Mutignani (M)

Emanuele Neri (E)

Fabiola Paiar (F)

Michele Reni (M)

Maria Isabella Rotondo (MI)

Nicola Silvestris (N)

Giampaolo Tortora (G)

Enrico Vasile (E)

Duccio Volterrani (D)

Informations de copyright

Déclaration de conflit d'intérêts

Conflicts of Interest and Source of Funding: The authors have the following conflicts of interest to disclose: S. George Barreto: support from Flinders Foundation grant: 49358025, NHMRC Ideas Grant: 2021009, Pankind 21.R7.INV.CB.UOSA.6.2. Fabrizio Michelassi: Tsumura, Inc., Scientific Advisory Board. Dr. Del Chiaro: is a co-PI of a Boston Scientific sponsored study and he has been awarded an industry grant by Haemonetics, Inc. Melissa Hogg: Intuitive Surgical – teaches courses and proctors. All the other authors have no conflict of interest to disclose