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An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer.
Cizmic, Amila; Romic, Ivan; Balla, Andrea; Barabino, Nicolò; Anania, Gabriele; Baiocchi, Gian Luca; Bakula, Branko; Balagué, Carmen; Berlth, Felix; Bintintan, Vasile; Bracale, Umberto; Egberts, Jan-Hendrik; Fuchs, Hans F; Gisbertz, Suzanne S; Gockel, Ines; Grimminger, Peter; van Hillegersberg, Richard; Inaki, Noriyuki; Immanuel, Arul; Korr, Daniel; Lingohr, Philipp; Mascagni, Pietro; Melling, Nathaniel; Milone, Marco; Mintz, Yoav; Morales-Conde, Salvador; Moulla, Yusef; Müller-Stich, Beat P; Nakajima, Kiyokazu; Nilsson, Magnus; Reeh, Matthias; Sileri, Pierpaolo; Targarona, Eduardo M; Ushimaru, Yuki; Kim, Young-Woo; Markar, Sheraz; Nickel, Felix; Mitra, Anuja T.
Afiliación
  • Cizmic A; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. a.cizmic@uke.de.
  • Romic I; Department of Hepatobiliary Surgery & Liver Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia.
  • Balla A; Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Barabino N; Department of Surgical Sciences & Integrated Diagnostic, University of Genoa, Genoa, Italy.
  • Anania G; Department of Medical Science, University of Ferrara, 4121, Ferrara, Italy.
  • Baiocchi GL; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
  • Bakula B; Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia.
  • Balagué C; Department of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
  • Berlth F; Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
  • Bintintan V; Department of Surgery, University Hospital Cluj Napoca, Cluj-Napoca, Romania.
  • Bracale U; General and Emergency Surgical Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, AOU San Giovanni and Ruggi D'Aragona, Salerno, Italy.
  • Egberts JH; Department of Surgery, Israelit Hospital, Hamburg, Germany.
  • Fuchs HF; Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany.
  • Gisbertz SS; Department of Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, The Netherlands.
  • Gockel I; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • Grimminger P; Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
  • van Hillegersberg R; Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
  • Inaki N; Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
  • Immanuel A; Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
  • Korr D; Northern Oesophago-Gastric Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
  • Lingohr P; Department of Surgery, Israelit Hospital, Hamburg, Germany.
  • Mascagni P; Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany.
  • Melling N; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Milone M; Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France.
  • Mintz Y; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
  • Morales-Conde S; Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131, Naples, Italy.
  • Moulla Y; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
  • Müller-Stich BP; Department of General and Digestive Surgery, University Hospital Virgen Macarena, School of Medicine of the University of Seville, Seville, Spain.
  • Nakajima K; Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain.
  • Nilsson M; Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
  • Reeh M; Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland.
  • Sileri P; Department of Next Generation Endoscopic Intervention, Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
  • Targarona EM; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
  • Ushimaru Y; Department of General, Visceral and Vascular Surgery, Marienkrankenhaus, Hamburg, Germany.
  • Kim YW; Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
  • Markar S; Surgery Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Nickel F; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
  • Mitra AT; Center for Gastric Cancer, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Surg Endosc ; 38(2): 488-498, 2024 Feb.
Article en En | MEDLINE | ID: mdl-38148401
ABSTRACT

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.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias Gástricas Límite: Humans Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Alemania

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias Gástricas Límite: Humans Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Alemania