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

2024; Lippincott Williams & Wilkins; Linguagem: Inglês

10.1097/sla.0000000000006248

1528-1140

Ugo Boggi, Emanuele F. Kauffmann, Niccolò Napoli, Savio George Barreto, Marc G. Besselink, Giuseppe Fusai, Thilo Hackert, Mohammad Abu Hilal, Giovanni Marchegiani, Roberto Salvia, Shailesh Shrikhande, Mark J. Truty, Jens Werner, Christopher L. Wolfgang, Elisa Bannone, Giovanni Capretti, Alice Cattelani, Alessandro Coppola, Alessandro Cucchetti, Davide De Sio, Armando Di Dato, Giovanna Di Meo, Claudio Fiorillo, Cesare Gianfaldoni, Michael Ginesini, C Salinas, Quirino Lai, Mario Miccoli, Roberto Maria Montorsi, Michele Pagnanelli, Andrea Poli, Claudio Ricci, Francesco Sucameli, Domenico Tamburrino, Virginia Viti, Pietro Addeo, Sergio Alfieri, Philippe Bachellier, Gian Luca Baiocchi, Gianpaolo Balzano, Linda Barbarello, Alberto Brolese, Juli Busquets, Giovanni Butturini, Fabio Caniglia, Damiano Caputo, Riccardo Casadei, Xi Chunhua, Ettore Colangelo, Andrea Coratti, Francesca Costa, Francesco Crafa, Raffaele Dalla Valle, Luciano De Carlis, Roeland F. de Wilde, Marco Del Chiaro, Fabrizio Di Benedetto, Pierluigi Di Sebastiano, Safi Domak, Melissa E. Hogg, V. Egorov, Giorgio Ercolani, Giuseppe Maria Ettorre, Massimo Falconi, Giovanni Ferrari, Alessandro Ferrero, Marco Filauro, Alessandro Giardino, Gian Luca Grazi, Salvatore Gruttaduaria, Jakob R. Izbicki, Elio Jovine, Matthew H. G. Katz, Tobias Keck, Igor Khatkov, Gozo Kiguchi, David A. Kooby, Hauke Lang, Carlo Lombardo, Giuseppe Malleo, Marco Massani, Vincenzo Mazzaferro, Riccardo Memeo, Yi Miao, Kohei Mishima, Carlo Molino, Yuichi Nagakawa, Masafumi Nakamura, Bruno Nardo, Fabrizio Panaro, Claudio Pasquali, Vittorio Perrone, Elena Rangelova, Long Riu, Renato Romagnoli, Raffaele Romito, Edoardo Rosso, Richard D. Schulick, Ajith K. Siriwardena, Marcello Spampinato, Oliver Strobel, Mario Testini, Roberto Troisi, Faik G Uzunoglo, Umberto Valente, Luigi Veneroni, Alessandro Zerbi, Emilio Vicente, Fabio Vistoli, Marco Vivarelli, Go Wakabayashi, Giacomo Zanus, Amer H. Zureikat, Nicholas J. Zyromski, Roberto Coppola, Vito D’Andrea, José Davide, Christos Dervenis, Isabella Frigerio, Kevin C. Konlon, Fabrizio Michelassi, Marco Montorsi, William H. Nealon, Nazario Portolani, Donzília Sousa Silva, Giuseppe Bozzi, Viviana Nicoleta Ferrari, Maria Giovanna Trivella, John L. Cameron, Pierre‐Alain Clavien, Horacio J. Asbun,

Colorectal Cancer Screening and Detection

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.