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

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 the...

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Main Authors: Miao, Yi (Author) , Lu, Zipeng (Author) , Yeo, Charles J. (Author) , Vollmer, Charles M. (Author) , Fernandez-del Castillo, Carlos (Author) , Ghaneh, Paula (Author) , Halloran, Christopher M. (Author) , Kleeff, Jörg H. (Author) , Rooij, Thijs de (Author) , Werner, Jens (Author) , Flaconi, Massimo (Author) , Friess, Helmut (Author) , Zeh, Herbert J. (Author) , Izbicki, Jakob R. (Author) , He, Jin (Author) , Laukkarinen, Johanna (Author) , Dejong, Cees H. (Author) , Lillemoe, Keith D. (Author) , Conlon, Kevin (Author) , Takaori, Kyoichi (Author) , Gianotti, Luca (Author) , Besselink, Marc G. (Author) , Chiaro, Marco del (Author) , Montorsi, Marco (Author) , Tanaka, Masao (Author) , Bockhorn, Maximilian (Author) , Adham, Mustapha (Author) , Olah, Attila (Author) , Salvia, Roberto (Author) , Shrikhande, Shailesh V. (Author) , Hackert, Thilo (Author) , Shimosegawa, Tooru (Author) , Zureikat, Amer H. (Author) , Ceyhan, Güralp O. (Author) , Peng, Yunpeng (Author) , Wang, Guangfu (Author) , Huang, Xumin (Author) , Dervenis, Christos (Author) , Bassi, Claudio (Author) , Neoptolemos, John P. (Author) , Büchler, Markus W. (Author)
Format: Article (Journal)
Language:English
Published: 2 April 2020
In: Surgery
Year: 2020, Volume: 168, Issue: 1, Pages: 72-84
ISSN:1532-7361
DOI:10.1016/j.surg.2020.02.018
Online Access:Resolving-System, lizenzpflichtig: https://doi.org/10.1016/j.surg.2020.02.018
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Author Notes:Yi Miao, Zipeng Lu, Charles J.Yeo, Charles M. Vollmer, Carlos Fernandez-del Castillo, Paula Ghaneh, Christopher M. Halloran, Jörg Kleeff, Thijs de Rooij, Jens Werner, Massimo Falconi, Helmut Friess, Herbert J. Zeh, Jakob R. Izbicki, Jin He, Johanna Laukkarinen, Cees H. Dejong, Keith D. Lillemoe, Kevin Conlon, Kyoichi Takaori, Luca Gianotti, Marc G. Besselink, Marco Del Chiaro, Marco Montorsi, Masao Tanaka, Maximilian Bockhorn, Mustapha Adham, Attila Oláh, Roberto Salvia, Shailesh V. Shrikhande, Thilo Hackert, Tooru Shimosegawa, Amer H. Zureikat, Güralp O. Ceyhan, Yunpeng Peng, Guangfu Wang, Xumin Huang, Christos Dervenis, Claudio Bassi, John P.Neoptolemos, Markus W. Büchler, the International Study Group of Pancreatic Surgery (ISGPS)

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520 |a 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. 
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