John C Mansour1, Kenneth Chavin2, Gareth Morris-Stiff3, Susanne G Warner4, Kenneth Cardona5, Zhi V Fong6, Ajay Maker7, Steven K Libutti8, Robert Warren9, Charles St Hill10, Scott Celinski11, Philippa Newell12, Quan P Ly13, James Howe14, Natalie Coburn15. 1. Department of Surgery, UT Southwestern, Dallas, TX, USA. Electronic address: john.mansour@utsouthwestern.edu. 2. Department of Surgery, University Hospitals, Cleveland, OH, USA. 3. Department of Surgery, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Surgery, City of Hope, Duarte, CA, USA. 5. Department of Surgery, Emory University, Atlanta, GA, USA. 6. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 7. Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. 8. Department of Surgery, Rutgers Cancer Institute of New Jersey, NJ, USA. 9. Department of Surgery, University of California, San Francisco, CA, USA. 10. Department of Surgery, University of Nevada Las Vegas, Las Vegas, NV, USA. 11. Department of Surgery, Baylor Scott and White, Dallas, TX, USA. 12. Department of Surgery, Providence Portland Medical Center, Portland, OR, USA. 13. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. 14. Department of Surgery, University of Iowa College of Medicine, Iowa City, IA, USA. 15. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, USA.
Abstract
BACKGROUND: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs. METHODS: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed. RESULTS: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for <1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1-2 cm tumors. CONCLUSIONS: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.
BACKGROUND: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs. METHODS: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed. RESULTS: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for <1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1-2 cm tumors. CONCLUSIONS: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.
Authors: James R Howe; Nipun B Merchant; Claudius Conrad; Xavier M Keutgen; Julie Hallet; Jeffrey A Drebin; Rebecca M Minter; Terry C Lairmore; Jennifer F Tseng; Herbert J Zeh; Steven K Libutti; Gagandeep Singh; Jeffrey E Lee; Thomas A Hope; Michelle K Kim; Yusuf Menda; Thorvardur R Halfdanarson; Jennifer A Chan; Rodney F Pommier Journal: Pancreas Date: 2020-01 Impact factor: 3.327