TY - JOUR
T1 - An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer
AU - Cizmic, Amila
AU - Romic, Ivan
AU - Balla, Andrea
AU - Barabino, Nicolò
AU - Anania, Gabriele
AU - Baiocchi, Gian Luca
AU - Bakula, Branko
AU - Balagué, Carmen
AU - Berlth, Felix
AU - Bintintan, Vasile
AU - Bracale, Umberto
AU - Egberts, Jan-Hendrik
AU - Fuchs, Hans F.
AU - Gisbertz, Suzanne S.
AU - Gockel, Ines
AU - Grimminger, Peter
AU - van Hillegersberg, Richard
AU - Inaki, Noriyuki
AU - Immanuel, Arul
AU - Korr, Daniel
AU - Lingohr, Philipp
AU - Mascagni, Pietro
AU - Melling, Nathaniel
AU - Milone, Marco
AU - Mintz, Yoav
AU - Morales-Conde, Salvador
AU - Moulla, Yusef
AU - Müller-Stich, Beat P.
AU - Nakajima, Kiyokazu
AU - Nilsson, Magnus
AU - Reeh, Matthias
AU - Sileri, Pierpaolo
AU - Targarona, Eduardo M.
AU - Ushimaru, Yuki
AU - Kim, Young-Woo
AU - Markar, Sheraz
AU - Nickel, Felix
AU - Mitra, Anuja T.
N1 - Publisher Copyright: © 2023, The Author(s).
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Consensus
KW - Delphi
KW - Gastrectomy
KW - International
KW - Laparoscopy
KW - Lymphadenectomy
KW - Minimally invasive surgery
KW - Surgical quality assessment
KW - Technical skills
UR - http://www.scopus.com/inward/record.url?scp=85180722050&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-023-10614-9
DO - https://doi.org/10.1007/s00464-023-10614-9
M3 - Article
C2 - 38148401
SN - 0930-2794
JO - Surgical endoscopy
JF - Surgical endoscopy
ER -