TY - JOUR
T1 - REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer
AU - Boggi, Ugo
AU - Kauffmann, Emanuele
AU - Napoli, Niccolò
AU - Barreto, S George
AU - Multidisciplinary advisory board
AU - Besselink, Marc G
AU - Fusai, Giuseppe K
AU - Hackert, Thilo
AU - Abu Hilal, Mohammad
AU - Marchegiani, Giovanni
AU - Salvia, Roberto
AU - Shrikhande, Shailesh
AU - Truty, Mark
AU - Werner, Jens
AU - Wolfgang, Christopher
AU - Bannone, Elisa
AU - Capretti, Giovanni
AU - Cattelani, Alice
AU - Coppola, Alessandro
AU - Cucchetti, Alessandro
AU - De Sio, Davide
AU - Di Dato, Armando
AU - Di Meo, Giovanna
AU - Fiorillo, Claudio
AU - Gianfaldoni, Cesare
AU - Ginesini, Michael
AU - Hidalgo Salinas, Camila
AU - Lai, Quirino
AU - Miccoli, Mario
AU - Montorsi, Roberto
AU - Pagnanelli, Michele
AU - Poli, Andrea
AU - Ricci, Claudio
AU - Sucameli, Francesco
AU - Tamburrino, Domenico
AU - Viti, Virginia
AU - Addeo, Pietro F
AU - Alfieri, Sergio
AU - Bachellier, Philippe
AU - Baiocchi, Gianluca
AU - Balzano, Gianpaolo
AU - Barbarello, Linda
AU - Brolese, Alberto
AU - Busquets, Juli
AU - Butturini, Giovanni
AU - Caniglia, Fabio
AU - Caputo, Damiano
AU - Casadei, Riccardo
AU - Chunhua, Xi
AU - de Wilde, Roeland F
AU - Cameron, John
N1 - Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - OBJECTIVE: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).SUMMARY BACKGROUND DATA: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.METHODS: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.RESULTS: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ).CONCLUSIONS: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.
AB - OBJECTIVE: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).SUMMARY BACKGROUND DATA: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.METHODS: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.RESULTS: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ).CONCLUSIONS: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.
UR - http://www.scopus.com/inward/record.url?scp=85191735776&partnerID=8YFLogxK
U2 - 10.1097/sla.0000000000006248
DO - 10.1097/sla.0000000000006248
M3 - Article
C2 - 38407228
SN - 0003-4932
VL - 280
SP - 56
EP - 65
JO - Annals of Surgery
JF - Annals of Surgery
IS - 1
ER -
