The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Pancreatic Cancer Research

Background:

• The role of minimally invasive surgery (MIPS) in pancreatic cancer remains debated despite its acceptance in other surgical fields.
• The São Paulo Consensus aimed to create consensus statements on MIPS for pancreatic cancer, incorporating current evidence and advancements.

Purpose of the Study:

• To establish evidence-based consensus statements on the application of minimally invasive pancreatic surgery (MIPS) for pancreatic cancer.
• To provide guidance on patient evaluation, surgical techniques, and implementation strategies for MIPS in pancreatic cancer.

Main Methods:

• A scoping literature review was conducted across five key thematic areas related to MIPS for pancreatic cancer.
• A modified Delphi process involving 52 international expert pancreas surgeons was employed over three rounds.
• Consensus was defined as achieving at least 90% agreement among the expert panel.

Main Results:

• 185 studies were selected from 2590 publications to inform statement development.
• 22 out of 28 statements achieved the ≥90% agreement threshold through the Delphi process.
• Recommendations cover minimally invasive resection for pancreatic cancer, neuroendocrine tumors, patient evaluation, and program implementation.

Conclusions:

• The São Paulo Consensus provides contemporary, evidence-based recommendations for minimally invasive pancreatic surgery.
• These guidelines support the safe and judicious adoption, implementation, and practice of MIPS in pancreatic cancer care.