Objective: The REDISCOVER consensus conference aimed at developing and validating guidelines on the perioperative care of patients with borderline-resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Background: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports the 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 a 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 nonsurgical 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 means 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-PDAC and LA-PDAC, and serve as the basis of a new international registry for this patient population.

REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer / U. Boggi, E. Kauffmann, N. Napoli, S.G. Barreto, M.G. Besselink, G.K. Fusai, T. Hackert, M. Abu Hilal, G. Marchegiani, R. Salvia, S.V. Shrikhande, M. Truty, J. Werner, C.L. Wolfgang, E. Bannone, G. Capretti, A. Cattelani, A. Coppola, A. Cucchetti, D. De Sio, A. Di Dato, G. Di Meo, C. Fiorillo, C. Gianfaldoni, M. Ginesini, C. Hidalgo Salinas, Q. Lai, M. Miccoli, R. Montorsi, M. Pagnanelli, A. Poli, C. Ricci, F. Sucameli, D. Tamburrino, V. Viti, P.F. Addeo, S. Alfieri, P. Bachellier, G.L. Baiocchi, G. Balzano, L. Barbarello, A. Brolese, J. Busquets, G. Butturini, F. Caniglia, D. Caputo, R. Casadei, X. Chunhua, E. Colangelo, A. Coratti, F. Costa, F. Crafa, R. Dalla Valle, L. De Carlis, R.F. de Wilde, M. Del Chiaro, F. Di Benedetto, P. Di Sebastiano, S. Dokmak, M. Hogg, V.I. Egorov, G. Ercolani, G.M. Ettorre, M. Falconi, G. Ferrari, A. Ferrero, M. Filauro, A. Giardino, G.L. Grazi, S. Gruttadauria, J.R. Izbicki, E. Jovine, M. Katz, T. Keck, I. Khatkov, G. Kiguchi, D. Kooby, H. Lang, C. Lombardo, G. Malleo, M. Massani, V. Mazzaferro, R. Memeo, Y. Miao, K. Mishima, C. Molino, Y. Nagakawa, M. Nakamura, B. Nardo, F. Panaro, C. Pasquali, V. Perrone, E. Rangelova, R. Liu, R. Romagnoli, R. Romito, E. Rosso, R. Schulick, A. Siriwardena, M.G. Spampinato, O. Strobel, M. Testini, R.I. Troisi, F.G. Uzunoglo, R. Valente, L. Veneroni, A. Zerbi, E. Vicente, F. Vistoli, M. Vivarelli, G. Wakabayashi, G. Zanus, A. Zureikat, N.J. Zyromski, R. Coppola, V. D'Andrea, J. Davide, C. Dervenis, I. Frigerio, K.C. Konlon, F. Michelassi, M. Montorsi, W. Nealon, N. Portolani, D. Sousa Silva, G. Bozzi, V. Ferrari, M.G. Trivella, J. Cameron, P. Clavien, H.J. Asbun, N. Null. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - 280:1(2024 Jul 01), pp. 56-65. [10.1097/sla.0000000000006248]

REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

G. Ferrari
Membro del Collaboration Group
;
V. Mazzaferro
Membro del Collaboration Group
;
2024

Abstract

Objective: The REDISCOVER consensus conference aimed at developing and validating guidelines on the perioperative care of patients with borderline-resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Background: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports the 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 a 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 nonsurgical 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 means 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-PDAC and LA-PDAC, and serve as the basis of a new international registry for this patient population.
borderline-resectable pancreatic cancer; locally advanced pancreatic cancer; pancreatectomy with vascular resection; REDISCOVER Guidelines; REDISCOVER registry;
Settore MED/18 - Chirurgia Generale
1-lug-2024
Article (author)
File in questo prodotto:
File Dimensione Formato  
rediscover_international_guidelines_on_the.11.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 403.84 kB
Formato Adobe PDF
403.84 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1079348
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 4
  • ???jsp.display-item.citation.isi??? ND
social impact