An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer
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Published:2023-12-26
Issue:2
Volume:38
Page:488-498
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ISSN:0930-2794
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Container-title:Surgical Endoscopy
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language:en
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Short-container-title:Surg Endosc
Author:
Cizmic AmilaORCID, 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.
Abstract
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.
Funder
European Association for Endoscopic Surgery and other Interventional Techniques Universitätsklinikum Hamburg-Eppendorf (UKE)
Publisher
Springer Science and Business Media LLC
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