Assessing the Potential Difficulty of Left Pancreatectomy: International Modified Delphi Consensus

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Education

Background:

• Left pancreatectomy (LP) is the standardized term for distal pancreatectomy.
• LP encompasses various techniques with differing complexities.
• Identifying factors influencing LP difficulty is essential for surgical planning.

Purpose of the Study:

• To establish consensus on factors contributing to the difficulty of left pancreatectomy.
• To facilitate the selection of optimal surgical strategies for LP.
• To provide a framework for stratifying LP complexity.

Main Methods:

• A four-phase Delphi consensus process involving 58 expert pancreatic surgeons from 14 countries.
• Surgeons rated agreement on difficulty factors using a 5-point Likert scale over two survey rounds.
• Consensus was defined as ≥70% agreement for inclusion in final recommendations.

Main Results:

• Ten difficulty parameters for LP achieved ≥70% consensus.
• Key factors include prior pancreatic surgery, pancreatitis history, tumor location, BMI, cirrhosis, and vessel infiltration.
• Previous pancreatic surgery and multi-visceral resection were highest (90.7%), followed by acute pancreatitis (88.9%).

Conclusions:

• An international Delphi study successfully identified and agreed upon 10 statements stratifying LP difficulty.
• These consensus statements provide valuable insights for surgical planning and strategy selection.
• Prospective validation is recommended to confirm the utility of these findings.