International expert consensus on laparoscopic pancreaticoduodenectomy

Renyi Qin¹, Michael L Kendrick², Christopher L Wolfgang³, Barish H Edil⁴, Chinnusamy Palanivelu⁵, Rowan W Parks⁶, Yinmo Yang⁷, Jin He⁸, Taiping Zhang⁹, Yiping Mou¹⁰, Xianjun Yu¹¹, Bing Peng¹², Palanisamy Senthilnathan⁵, Ho-Seong Han¹³, Jae Hoon Lee¹⁴, Michiaki Unno¹⁵, Steven W M Olde Damink¹⁶, Virinder Kumar Bansal¹⁷, Pierce Chow¹⁸, Tan To Cheung¹⁹, Nim Choi²⁰, Yu-Wen Tien²¹, Chengfeng Wang²², Manson Fok²³, Xiujun Cai²⁴, Shengquan Zou¹, Shuyou Peng²⁵, Yupei Zhao⁹

Affiliations

¹ Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Mayo Clinic, Rochester, MN, USA.
³ Division of Surgical Oncology, Department of Surgery, The John Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA.
⁵ Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
⁶ Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
⁷ Department of General Surgery, Peking University First Hospital, Beijing, China.
⁸ Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁹ Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁰ Department of Gastroenterology and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
¹¹ Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
¹² Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
¹³ Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
¹⁴ Division of Hepatopancreatobiliary Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea.
¹⁵ Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁶ Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹⁷ Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
¹⁸ Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.
¹⁹ Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
²⁰ Department of General Surgery, Hospital Conde S. Januário, Macau, China.
²¹ Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
²² Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²³ Department of Surgery, University Hospital, Macau University of Science and Technology, Macau, China.
²⁴ Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China.
²⁵ Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

PMID: 32832497
PMCID: PMC7423539
DOI: 10.21037/hbsn-20-446

Review

International expert consensus on laparoscopic pancreaticoduodenectomy

Renyi Qin et al. Hepatobiliary Surg Nutr. 2020 Aug.

. 2020 Aug;9(4):464-483.

doi: 10.21037/hbsn-20-446.

Authors

Affiliations

¹ Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Mayo Clinic, Rochester, MN, USA.
³ Division of Surgical Oncology, Department of Surgery, The John Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA.
⁵ Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
⁶ Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
⁷ Department of General Surgery, Peking University First Hospital, Beijing, China.
⁸ Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁹ Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁰ Department of Gastroenterology and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
¹¹ Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
¹² Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
¹³ Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
¹⁴ Division of Hepatopancreatobiliary Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea.
¹⁵ Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁶ Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹⁷ Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
¹⁸ Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.
¹⁹ Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
²⁰ Department of General Surgery, Hospital Conde S. Januário, Macau, China.
²¹ Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
²² Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²³ Department of Surgery, University Hospital, Macau University of Science and Technology, Macau, China.
²⁴ Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China.
²⁵ Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

PMID: 32832497
PMCID: PMC7423539
DOI: 10.21037/hbsn-20-446

Abstract

Importance: While laparoscopic pancreaticoduodenectomy (LPD) is being adopted with increasing enthusiasm worldwide, it is still challenging for both technical and anatomical reasons. Currently, there is no consensus on the technical standards for LPD.

Objective: The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.

Evidence review: An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy. Statements were produced upon reviewing the literature and assessed by the members of the expert panel. The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019. The Web of Science, Medline, and Cochrane Library and Clinical Trials databases were searched, The search strategy included, but was not limited to, the terms 'laparoscopic', 'pancreaticoduodenectomy, 'pancreatoduodenectomy', 'Whipple's operation', and 'minimally invasive surgery'. Reference lists from the included articles were manually checked for any additional studies, which were included when appropriate. Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements. The statements were further discussed during a one-day face-to-face meeting at the 1^st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan, China.

Findings: Twenty-eight international experts from 8 countries constructed the expert panel. Sixteen statements were produced by the members of the expert panel. At least 80% of responders agreed with the majority (80%) of statements. Other than three randomized controlled trials published to date, most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument.

Conclusions and relevance: The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD. LPD is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.

Keywords: Consensus; Delphi technique; laparoscopy; pancreaticoduodenectomy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn-20-446). The authors have no conflicts of interest to declare.

Figures

**Figure 1**
PRISMA diagram. Graphical representation of the publications that were reviewed in the process of generating this consensus statement. Three independent literature searches were performed, with each search including ‘(pancreatoduodenectomy OR pancreaticoduodenectomy) AND laparoscopic’. Level of evidence was graded according to the Oxford Centre for Evidence-based Medicine from 1 to 5.

See this image and copyright information in PMC

Comment in

Safety and feasibility of laparoscopic pancreatoduodenectomy.
Nakagawa N, Nagakawa Y, Kozono S. Nakagawa N, et al. Hepatobiliary Surg Nutr. 2022 Apr;11(2):330-332. doi: 10.21037/hbsn-21-533. Hepatobiliary Surg Nutr. 2022. PMID: 35464277 Free PMC article. No abstract available.

References

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International expert consensus on laparoscopic pancreaticoduodenectomy

Affiliations

International expert consensus on laparoscopic pancreaticoduodenectomy

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

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