Journal article
Management of asymptomatic, well-differentiated PNETs: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association
HPB (Oxford, England), Vol.21(5), pp.515-523
05/01/2019
DOI: 10.1016/j.hpb.2018.09.020
PMID: 30527517
Abstract
Background: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs.
Methods: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed.
Results: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for < 1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1-2 cm tumors.
Conclusions: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.
Details
- Title: Subtitle
- Management of asymptomatic, well-differentiated PNETs: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association
- Creators
- John C. Mansour - The University of Texas Southwestern Medical CenterKenneth Chavin - University Hospitals of ClevelandGareth Morris-Stiff - Cleveland ClinicSusanne G. Warner - City Of Hope National Medical CenterKenneth Cardona - Emory UniversityZhi V. Fong - Massachusetts General HospitalAjay Maker - University of Illinois at ChicagoSteven K. Libutti - Rutgers, The State University of New JerseyRobert Warren - University of California, San FranciscoCharles St Hill - University of Nevada RenoScott Celinski - Baylor Medical Center at GarlandPhilippa Newell - Providence Portland Medical CenterQuan P. Ly - University of Nebraska Medical CenterJames Howe - University of IowaNatalie Coburn - Sunnybrook Health Science Centre
- Resource Type
- Journal article
- Publication Details
- HPB (Oxford, England), Vol.21(5), pp.515-523
- Publisher
- Elsevier
- DOI
- 10.1016/j.hpb.2018.09.020
- PMID
- 30527517
- ISSN
- 1365-182X
- eISSN
- 1477-2574
- Number of pages
- 9
- Grant note
- P50 CA174521 / NCI NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) P50CA174521 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI)
- Language
- English
- Date published
- 05/01/2019
- Academic Unit
- Surgery
- Record Identifier
- 9984322929002771
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