Anastomotic leak following oesophagectomy: research priorities from an international Delphi consensus study

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Anastomotic leak following oesophagectomy: research priorities from an international Delphi consensus study


JournalBritish Journal of Surgery
Article typeJournal research article – Clinical research
Publication date – Dec – 2020
Authors – Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative
Keywordsanastomosis, anastomotic leak, cancer, ischemic preconditioning, minimally invasive, operative science of nutrition, participation in ward rounds gastric tube reconstruction consensus, preoperative care, surgical esophagectomy, surgical oncology, Surgical Procedures
Open access – Yes
SpecialityGeneral surgery, Surgical oncology
World region Global

Language – English
Submitted to the One Surgery Index on December 26, 2020 at 2:11 pm
Abstract:

Background
The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks.

Methods
A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three‐stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income.

Results
In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis.

Conclusion
Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.

OSI Number – 20816

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