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

Y. Miao*, Z.P. Lu, C.J. Yeo, C.M. Vollmer, C. Fernandez-del Castillo, P. Ghaneh, C.M. Halloran, J. Kleeff, T. de Rooij, J. Werner, M. Falconi, H. Friess, H.J. Zeh, J.R. Izbicki, J. He, J. Laukkarinen, C.H. Dejong, K.D. Lillemoe, K. Conlon, K. TakaoriL. Gianotti, M.G. Besselink, M. Del Chiaro, M. Montorsi, M. Tanaka, M. Bockhorn, M. Adham, A. Olah, R. Salvia, S.V. Shrikhande, T. Hackert, T. Shimosegawa, A.H. Zureikat, G.O. Ceyhan, Y.P. Peng, G.F. Wang, X.M. Huang, C. Dervenis, C. Bassi, J.P. Neoptolemos, M.W. Buchler, International Study Group of Pancreatic Surgery (ISGPS)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Web of Science)

Abstract

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. (C) 2020 Elsevier Inc. All rights reserved.
Original languageEnglish
Pages (from-to)72-84
Number of pages13
JournalSurgery
Volume168
Issue number1
DOIs
Publication statusPublished - 1 Jul 2020

Keywords

  • fistula formation
  • hand-sewn closure
  • polyglycolic acid felt
  • randomized controlled-trial
  • remnant closure
  • risk-factors
  • soft coagulation
  • staple line reinforcement
  • stump closure
  • to-mucosa pancreaticogastrostomy
  • RISK-FACTORS
  • STAPLE LINE REINFORCEMENT
  • RANDOMIZED CONTROLLED-TRIAL
  • POLYGLYCOLIC ACID FELT
  • FISTULA FORMATION
  • STUMP CLOSURE
  • REMNANT CLOSURE
  • SOFT COAGULATION
  • TO-MUCOSA PANCREATICOGASTROSTOMY
  • HAND-SEWN CLOSURE

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