Standardization of laparoscopic total mesorectal excision for rectal cancer: A structured international expert consensus

Danilo Miskovic, Jake Foster, Ayman Agha, Conor P. Delaney, Nader Francis, Hirotoshi Hasegawa, Alexey Karachun, Seon Hahn Kim, Wai Lun Law, John Marks, Mario Morino, Yves Panis, Juan Carlos Patrón Uriburu, Steven D. Wexner, Amjad Parvaiz

    Research output: Contribution to journalArticlepeer-review

    46 Citations (Scopus)

    Abstract

    Objective: To establish a structured international expert consensus on a detailed technical description of the laparoscopic total mesorectal excision (TME). Background: Laparoscopic TME is a common surgical approach for the treatment of rectal cancer, but there is little agreement on technical details and standards. Methods: 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. Findings: 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. Conclusions: This detailed and agreed technical description of laparoscopic TME may have implications on training, assessment, quality control, and future research.

    Original languageEnglish
    Pages (from-to)716-722
    Number of pages7
    JournalAnnals of surgery
    Volume261
    Issue number4
    DOIs
    Publication statusPublished - 2015 Apr

    Keywords

    • Colorectal surgery
    • Consensus
    • Expert
    • Laparoscopic
    • Rectal cancer
    • Total mesorectal excision

    ASJC Scopus subject areas

    • Surgery

    Fingerprint

    Dive into the research topics of 'Standardization of laparoscopic total mesorectal excision for rectal cancer: A structured international expert consensus'. Together they form a unique fingerprint.

    Cite this