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

Left pancreatectomy (LP) is the consensus term for the surgical procedure previously known as distal pancreatectomy. Several approaches and techniques are included in the LP definition, with varying difficulty. Several factors may contribute to the difficulty of LP. This study aimed to identify these factors to facilitate selecting the optimal surgical strategy.

A 4-phase Delphi consensus process was undertaken. Participants were asked to indicate their "agreement/disagreement" on each question on a 5-point Likert scale. For inclusion in the final recommendations, each question reached a ≥70% consensus by the end of the 2 survey rounds. Finally, we generate Delphi recommendations.

The survey was sent to 58 expert pancreatic surgeons from 14 countries, with 51 in both rounds. The median age of participants was 53 years (interquartile range 47 to 60 years) with a median center LP volume of 20 in 2023 (interquartile range 13 to 40). Twelve centers did not perform robotic LP. Eleven questions reached 70% agreement in the first round. The 10 difficulty parameters sorted by the percentage of the agreement after 2 rounds were previous pancreatic surgery and multivisceral resection (90.7%), previous acute pancreatitis (88.9%), tumor located in the neck (88.9%), chronic pancreatitis (87.0%), BMI greater than 30 kg/m 2 (83.3%), cirrhosis (79.6%), previous supramesocolic surgery (excluding cholecystectomy; 75.9%), splenic arterial or venous infiltration (74.1%), and splenic vessels preservation (72.2%). Delta measurement between both rounds showed no statistical difference.

This international Delphi study led to an agreement on 10 statements stratifying the difficulty of LP. Validation in a prospective series would be useful to confirm the feasibility and use of this Delphi study.