RESUMO
BACKGROUND: Increased incorporation of minimally invasive pancreatic resections (MIPR) has emerged into hepato-pancreato-biliary practice, however, no standardization exists for its safe adoption. Novel strategies are presented for dissemination of safe MIPR. METHODS: An international State-of-the-Art conference evaluating multiple aspects of MIPR was conducted by a panel of pancreas experts in Sao Paulo, Brazil on April 20, 2016. Training and education issues were discussed regarding the introduction of novel strategies for safe dissemination of MIPR. RESULTS: The low volume of pancreatic resections per institution poses a challenge for surgeons to overcome their MIPR learning curve without deliberate training. A mastery-based simulation and biotissue curriculum can improve technical proficiency and allow for training of surgeons before the operating room. Video-based platforms allow for performance reporting and feedback necessary for coaching and surgical quality improvement. Centers of excellence with training involving a standardized approach and proctorship are important concepts that can be utilized in various formats internationally. DISCUSSION: Surgical volume is not sufficient to ensure quality and patient safety in MIPR. Safe adoption of these complex procedures should consider innovative mastery-based training outside of the operating room, novel video based coaching techniques and prospective reporting of patient data and outcomes using standardized definitions.
Assuntos
Educação de Pós-Graduação em Medicina/métodos , Laparoscopia/educação , Pancreatectomia/educação , Pancreaticoduodenectomia/educação , Procedimentos Cirúrgicos Robóticos/educação , Cirurgiões/educação , Competência Clínica , Congressos como Assunto , Currículo , Educação de Pós-Graduação em Medicina/normas , Treinamento com Simulação de Alta Fidelidade , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/normas , Curva de Aprendizado , Pancreatectomia/efeitos adversos , Pancreatectomia/normas , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/normas , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/normas , Cirurgiões/normas , Resultado do TratamentoRESUMO
Neoadjuvant chemoradiotherapy can be administered safely to patients with pancreatic cancer. Complete pathologic responses are rare, however, and the benefits of this approach compared with standard adjuvant therapy are uncertain. The only way to evaluate the efficacy of neoadjuvant chemoradiotherapy is a prospective trial involving a uniform patient population comparing the results of neoadjuvant and adjuvant therapy and a cohort receiving surgery alone. Such a study can be designed in an ethically sound manner but requires the collaboration of numerous institutions and careful coordination to achieve statistically conclusive results. The future of pancreatic cancer research rests on the availability and rapid transfer of new therapies from the laboratory to clinical research.