Standardization of Laparoscopic Total Mesorectal Excision for Rectal Cancer. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Miskovic, Danilo; Foster, Jake; Agha, Ayman; Delaney, Conor P.; Francis, Nader; Hasegawa, Hirotoshi; Karachun, Alexey; Kim, Seon Hahn; Law, Wai Lun; Marks, John; Morino, Mario; Panis, Yves; Uriburu, Juan Carlos Patrón; Wexner, Steven D.; Parvaiz, Amjad
• Is Part Of: Annals of surgery. Volume 261:Issue 4(2015:Apr.)
• Publication Date: 2015-04
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000823
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To establish a structured international expert consensus on a detailed technical description of the laparoscopic total mesorectal excision (TME).</p> </sec> <sec> <title>Background:</title> <p>Laparoscopic TME is a common surgical approach for the treatment of rectal cancer, but there is little agreement on technical details and standards.</p> </sec> <sec> <title>Methods:</title> <p>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.</p> </sec> <sec> <title>Findings:</title> <p>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.</p> </sec> <sec> <title>Conclusions:</title> <p>This detailed and agreed technical description of laparoscopic TME may have implications on training, assessment, quality control, and future research.</p> </sec> </abstract>