An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer.
An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer.
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DOI：
10.1007/s00464-023-10614-9
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发表时间：
2024-02
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微创全胃切除术（MITG）是胃癌根治性治疗的主要手段。为了通过提高MITG手术质量来定义和规范最佳手术技术，进一步提高临床疗效，必须对淋巴结切除和吻合口形成的关键技术步骤达成共识，这是目前缺乏的。本研究旨在从一个国际小组中确定专家共识，关于使用德尔菲法对肿瘤指征进行MITG的技术方面的表现。通过本地和国际专家意见和文献证据，将MITG解构为其关键技术步骤，并创建了一个100点范围调查。由上胃肠外科医生和普通外科医生组成的国际专家小组参加了多轮德尔菲共识。小组成员通过在线问卷对重要性、难度或一致性等问题进行投票。一个先验的共识标准被设定为bbbb80 %同意一项声明。采用Cronbach’s α评价内部一致性和信度。30位上消化道和普通外科专家参与了三次在线德尔菲轮次，最终就胃癌MITG的41项声明达成共识。从德尔菲第1轮、第2轮和第3轮的22个、12个和7个问题中获得了共识，这些问题分别被重新表述为41个陈述。对于淋巴结切除术和吻合口建立方面，根据难度和重要性，第1轮的Cronbach’s α分别为0.896和0.886，第2轮的Cronbach’s α分别为0.848和0.779。德尔菲共识定义了41个步骤，作为根据国际专家组标准进行高质量肿瘤适应症MITG的关键步骤。这一共识的结果为创建和验证旨在改善MITG临床结果和标准化手术质量的手术质量评估工具提供了一个平台。在线版本包含补充材料，可在10.1007/s00464-023-10614-9获得。
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. 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. 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. 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. The online version contains supplementary material available at 10.1007/s00464-023-10614-9.
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DOI：
10.1136/bmj.i1152
发表时间：
2016-03-08
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Brouwers MC;Kerkvliet K;Spithoff K;AGREE Next Steps Consortium
通讯作者：
AGREE Next Steps Consortium
DOI：
10.1007/s00464-017-5942-x
发表时间：
2018-05-01
影响因子：
3.1
作者：
Shi, Yan;Xu, Xianhui;Yu, Peiwu
通讯作者：
Yu, Peiwu
影响因子：
2.9
作者：
通讯作者：
--
DOI：
10.1007/s00464-015-4206-x
发表时间：
2016-01-01
影响因子：
3.1
作者：
Khamis, Nehal N.;Satava, Richard M.;Kern, David E.
通讯作者：
Kern, David E.
影响因子：
0.8
作者：
Jiao J;Liu S;Chen C;Maimaiti A;He Q;Hu S;Yu W
通讯作者：
Yu W