Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS)

TY - JOUR

T1 - Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS)

AU - Miao, Yi

AU - Lu, Zipeng

AU - Yeo, Charles J

AU - Vollmer, Charles M

AU - Fernandez-Del Castillo, Carlos

AU - Ghaneh, Paula

AU - Halloran, Christopher M

AU - Kleeff, Jörg

AU - de Rooij, Thijs

AU - Werner, Jens

AU - Falconi, Massimo

AU - Friess, Helmut

AU - Zeh, Herbert J

AU - Izbicki, Jakob R

AU - He, Jin

AU - Laukkarinen, Johanna

AU - Dejong, Cees H

AU - Lillemoe, Keith D

AU - Conlon, Kevin

AU - Takaori, Kyoichi

AU - Gianotti, Luca

AU - Besselink, Marc G

AU - Del Chiaro, Marco

AU - Montorsi, Marco

AU - Tanaka, Masao

AU - Bockhorn, Maximilian

AU - Adham, Mustapha

AU - Oláh, Attila

AU - Salvia, Roberto

AU - Shrikhande, Shailesh V

AU - Hackert, Thilo

AU - Shimosegawa, Tooru

AU - Zureikat, Amer H

AU - Ceyhan, Güralp O

AU - Peng, Yunpeng

AU - Wang, Guangfu

AU - Huang, Xumin

AU - Dervenis, Christos

AU - Bassi, Claudio

AU - Neoptolemos, John P

AU - Büchler, Markus W

AU - International Study Group on Pancreatic Surgery (ISGPS)

N1 - Copyright © 2020 Elsevier Inc. All rights reserved.

PY - 2020/7

Y1 - 2020/7

N2 - BACKGROUND: The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines.METHODS: Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the level of objective support for each.RESULTS: Studies using the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula including 16 randomized trials were reviewed to generate a series of statements set into 14 domains. There was strong consensus in the following statements: there was no difference in the postoperative pancreatic fistula rate after left pancreatectomy between the handsewn and stapler techniques; a stapling technique could not be used in all cases of left pancreatectomy; the use of an energy-based tissue sealant or a chemical sealant device or combinations of these did not impact the postoperative pancreatic fistula rate; there was no difference in the postoperative pancreatic fistula rate between the open, laparoscopic, or robotic approaches; and there are 1 or more clinically important, patient-related risk factors associated with the postoperative pancreatic fistula rate. There was weak or conditional agreement on the use of prophylactic somatostatin analogs, stents, stump closure, stump anastomosis, and the role of abdominal drains.CONCLUSION: Areas of strong consensus suggests a change in clinical practice and priority setting. Eight domains with lower agreement will require novel approaches and large multicenter studies to determine future key areas of practice.

AB - BACKGROUND: The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines.METHODS: Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the level of objective support for each.RESULTS: Studies using the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula including 16 randomized trials were reviewed to generate a series of statements set into 14 domains. There was strong consensus in the following statements: there was no difference in the postoperative pancreatic fistula rate after left pancreatectomy between the handsewn and stapler techniques; a stapling technique could not be used in all cases of left pancreatectomy; the use of an energy-based tissue sealant or a chemical sealant device or combinations of these did not impact the postoperative pancreatic fistula rate; there was no difference in the postoperative pancreatic fistula rate between the open, laparoscopic, or robotic approaches; and there are 1 or more clinically important, patient-related risk factors associated with the postoperative pancreatic fistula rate. There was weak or conditional agreement on the use of prophylactic somatostatin analogs, stents, stump closure, stump anastomosis, and the role of abdominal drains.CONCLUSION: Areas of strong consensus suggests a change in clinical practice and priority setting. Eight domains with lower agreement will require novel approaches and large multicenter studies to determine future key areas of practice.

U2 - 10.1016/j.surg.2020.02.018

DO - 10.1016/j.surg.2020.02.018

M3 - SCORING: Journal article

C2 - 32249092

VL - 168

SP - 72

EP - 84

JO - SURGERY

JF - SURGERY

SN - 0039-6060

IS - 1

ER -