Standardization of Laparoscopic Total Mesorectal Excision for Rectal Cancer A Structured International Expert Consensus

被引:70
作者
Miskovic, Danilo [1 ]
Foster, Jake [2 ]
Agha, Ayman [3 ]
Delaney, Conor P. [4 ]
Francis, Nader [5 ]
Hasegawa, Hirotoshi [6 ]
Karachun, Alexey [7 ]
Kim, Seon Hahn [8 ]
Law, Wai Lun [9 ]
Marks, John [10 ]
Morino, Mario [11 ]
Panis, Yves [12 ,13 ]
Patron Uriburu, Juan Carlos [14 ]
Wexner, Steven D. [15 ]
Parvaiz, Amjad [16 ]
机构
[1] St James Univ Hosp, John Goligher Dept Colorectal Surg, Leeds LS9 7TF, W Yorkshire, England
[2] Univ London Imperial Coll Sci Technol & Med, Dept Surg & Canc, London SW7 2AZ, England
[3] Univ Med Ctr Regensburg, Dept Surg, Regensburg, Germany
[4] Case Western Reserve Univ, Div Colorectal Surg, Cleveland, OH 44106 USA
[5] Yeovil Dist Hosp, Dept Surg, Yeovil, England
[6] Keio Univ, Dept Surg, Tokyo, Japan
[7] NN Petrov Oncol Res Inst, St Petersburg, Russia
[8] Korea Univ, Dept Surg, Seoul, South Korea
[9] Univ Hong Kong, Dept Surg, Hong Kong, Hong Kong, Peoples R China
[10] Lankenau Med Ctr, Div Colorectal Surg, Wynnewood, PA USA
[11] Univ Turin, Dept Surg Sci, Turin, Italy
[12] Beaujon Hosp, AP HP, Colorectal Dept, Clichy, France
[13] Univ Paris 07, F-75221 Paris 05, France
[14] British Hosp Buenos Aires, Dept Colorectal Surg, Buenos Aires, DF, Argentina
[15] Cleveland Clin Florida, Ctr Digest Dis, Dept Colorectal Surg, Weston, FL USA
[16] Queen Alexandra Hosp, Minimally Invas Colorectal Unit, Portsmouth, Hants, England
关键词
colorectal surgery; consensus; expert; laparoscopic; rectal cancer; total mesorectal excision; COLORECTAL SURGERY; BOWEL PREPARATION; MEDICAL-RESEARCH; CLASICC TRIAL; MULTICENTER; SURVIVAL;
D O I
10.1097/SLA.0000000000000823
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To establish a structured international expert consensus on a detailed technical description of the laparoscopic total mesorectal excision (TME). Background: Laparoscopic TME is a common surgical approach for the treatment of rectal cancer, but there is little agreement on technical details and standards. Methods: Sixty leading surgical experts from 5 different world regions with a median overall experience of 250 laparoscopic TME participated in this study. Four stages of mixed quantitative and qualitative consensus-finding methods were applied. (1) Semistructured expert interviews were independently analyzed by 2 assessors. (2) Consensus on the interview data was reached using reiterating questionnaires (Delphi method). (3) This was further refined in an interactive workshop. (4) Based on this meeting, a comprehensive text was drafted and final approval was sought by all experts. Findings: Three theme categories were identified in 9 detailed interviews (anatomical landmarks, description of tissue retraction, and operating strategies). Following 2 rounds of a 54-item questionnaire, 29 items achieved very high agreement (A* >= 90%), 14 with good agreement (>= 80%), 13 with moderate agreement (>= 50%), and 18 with little or no agreement (<50%). In the workshop, areas of agreement were consolidated and conclusions were sought for those with less agreement. The final document was approved after 2 further rounds of surveys by all respondents. Conclusions: This detailed and agreed technical description of laparoscopic TME may have implications on training, assessment, quality control, and future research.
引用
收藏
页码:716 / 722
页数:7
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