BACKGROUND: The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks. METHODS: A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three-stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income. RESULTS: In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis. CONCLUSION: Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.
BACKGROUND: The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks. METHODS: A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three-stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income. RESULTS: In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis. CONCLUSION: Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.
Authors: Sivesh K Kamarajah; Manjunath Siddaiah-Subramanya; Alessandro Parente; Richard P T Evans; Ademola Adeyeye; Alan Ainsworth; Alberto M L Takahashi; Alex Charalabopoulos; Andrew Chang; Atila Eroglue; Bas Wijnhoven; Claire Donohoe; Daniela Molena; Eider Talavera-Urquijo; Flavio Roberto Takeda; Gail Darling; German Rosero; Guillaume Piessen; Hans Mahendran; Hsu Po Kuei; Ines Gockel; Ionut Negoi; Jacopo Weindelmayer; Jari Rasanen; Kebebe Bekele; Guowei Kim; Lieven Depypere; Lorenzo Ferri; Magnus Nilsson; Frederik Klevebro; B Mark Smithers; Mark I van Berge Henegouwen; Peter Grimminger; Paul M Schneider; C S Pramesh; Raza Sayyed; Richard Babor; Shinji Mine; Simon Law; Suzanne Gisbertz; Tim Bright; Xavier Benoit D'Journo; Donald Low; Pritam Singh; Ewen A Griffiths Journal: Ann Surg Open Date: 2022-08-29