An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer,Surgical Endoscopy

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An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2023-12-26 , DOI: 10.1007/s00464-023-10614-9
Amila Cizmic ₁ , Ivan Romic ₂ , Andrea Balla ₃ , Nicolò Barabino ₄ , Gabriele Anania ₅ , Gian Luca Baiocchi ₆ , Branko Bakula ₇ , Carmen Balagué ₈ , Felix Berlth ₉ , Vasile Bintintan ₁₀ , Umberto Bracale ₁₁ , Jan-Hendrik Egberts ₁₂ , Hans F Fuchs ₁₃ , Suzanne S Gisbertz _{14,

15} , Ines Gockel ₁₆ , Peter Grimminger ₉ , Richard van Hillegersberg ₁₇ , Noriyuki Inaki ₁₈ , Arul Immanuel ₁₉ , Daniel Korr ₁₂ , Philipp Lingohr ₂₀ , Pietro Mascagni _{21,

22} , Nathaniel Melling ₁ , Marco Milone ₂₃ , Yoav Mintz ₂₄ , Salvador Morales-Conde _{25,

26} , Yusef Moulla ₁₆ , Beat P Müller-Stich ₂₇ , Kiyokazu Nakajima ₂₈ , Magnus Nilsson ₂₉ , Matthias Reeh ₃₀ , Pierpaolo Sileri ₃₁ , Eduardo M Targarona ₃₂ , Yuki Ushimaru ₃₃ , Young-Woo Kim ₃₄ , Sheraz Markar ₃₅ , Felix Nickel ₁ , Anuja T Mitra ₃₆

Affiliation

Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Hepatobiliary Surgery & Liver Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia.
Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Surgical Sciences & Integrated Diagnostic, University of Genoa, Genoa, Italy.
Department of Medical Science, University of Ferrara, 4121, Ferrara, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia.
Department of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Department of Surgery, University Hospital Cluj Napoca, Cluj-Napoca, Romania.
General and Emergency Surgical Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, AOU San Giovanni and Ruggi D'Aragona, Salerno, Italy.
Department of Surgery, Israelit Hospital, Hamburg, Germany.
Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany.
Department of Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, The Netherlands.
Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
Northern Oesophago-Gastric Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany.
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France.
Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131, Naples, Italy.
Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Department of General and Digestive Surgery, University Hospital Virgen Macarena, School of Medicine of the University of Seville, Seville, Spain.
Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain.
Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland.
Department of Next Generation Endoscopic Intervention, Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Department of General, Visceral and Vascular Surgery, Marienkrankenhaus, Hamburg, Germany.
Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Surgery Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Center for Gastric Cancer, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Department of Surgery & Cancer, Imperial College London, London, UK.

Background

Minimally invasive total gastrectomy (MITG) is a mainstay for curative treatment of patients with gastric cancer. To define and standardize optimal surgical techniques and further improve clinical outcomes through the enhanced MITG surgical quality, there must be consensus on the key technical steps of lymphadenectomy and anastomosis creation, which is currently lacking. This study aimed to determine an expert consensus from an international panel regarding the technical aspects of the performance of MITG for oncological indications using the Delphi method.

Methods

A 100-point scoping survey was created based on the deconstruction of MITG into its key technical steps through local and international expert opinion and literature evidence. An international expert panel comprising upper gastrointestinal and general surgeons participated in multiple rounds of a Delphi consensus. The panelists voted on the issues concerning importance, difficulty, or agreement using an online questionnaire. A priori consensus standard was set at > 80% for agreement to a statement. Internal consistency and reliability were evaluated using Cronbach's α.

Results

Thirty expert upper gastrointestinal and general surgeons participated in three online Delphi rounds, generating a final consensus of 41 statements regarding MITG for gastric cancer. The consensus was gained from 22, 12, and 7 questions from Delphi rounds 1, 2, and 3, which were rephrased into the 41 statetments respectively. For lymphadenectomy and aspects of anastomosis creation, Cronbach’s α for round 1 was 0.896 and 0.886, and for round 2 was 0.848 and 0.779, regarding difficulty or importance.

Conclusions

The Delphi consensus defined 41 steps as crucial for performing a high-quality MITG for oncological indications based on the standards of an international panel. The results of this consensus provide a platform for creating and validating surgical quality assessment tools designed to improve clinical outcomes and standardize surgical quality in MITG.

中文翻译：

胃癌微创全胃切除术中淋巴结清扫术和吻合术手术质量评估的国际 Delphi 共识

背景

微创全胃切除术（MITG）是胃癌患者根治性治疗的主要方法。为了定义和标准化最佳手术技术，并通过提高 MITG 手术质量进一步改善临床结果，必须就淋巴结清扫术和吻合术创建的关键技术步骤达成共识，而目前尚缺乏共识。本研究旨在确定国际小组关于使用 Delphi 方法治疗肿瘤适应症的 MITG 性能的技术方面的专家共识。

方法

通过本地和国际专家意见和文献证据，将 MITG 解构为其关键技术步骤，创建了一项 100 点范围界定调查。由上消化道和普通外科医生组成的国际专家小组参与了多轮 Delphi 共识。小组成员使用在线问卷对有关重要性、难度或协议的问题进行投票。先验共识标准设定为 > 80% 同意一项声明。使用 Cronbach α评估内部一致性和可靠性。

结果

30 名上消化道和普通外科医生专家参加了三轮在线 Delphi 轮次，就 MITG 治疗胃癌达成了 41 项声明的最终共识。共识是从 Delphi 第 1、2 和 3 轮的 22、12 和 7 个问题中获得的，这些问题分别被改写为 41 个陈述。对于淋巴结清扫术和吻合术创建的各个方面，第 1 轮的 Cronbach α为 0.896 和 0.886，第 2 轮为 0.848 和 0.779，关于难度或重要性。