An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey.
LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case-control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe.
LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.
根据腹腔镜和开放胰腺手术的临床和科学专业知识,选出了一个国际专家小组。在Delphi过程中,每位小组成员对文献进行了批判性评估,并准备了其他小组成员评估的基于证据的陈述。在为期一天的面对面会议之后的第二轮德尔福会议上进一步讨论了这些声明。修改后的声明已在阿姆斯特丹举行的第24届EAES国际大会全体会议和基于网络的调查中提出。
LAPS包括腹腔镜远端胰腺切除术(LDP),胰十二指肠切除术(LPD),摘除,中央胰腺切除术,和超声波。总的来说,洛杉矶被发现是安全的,尤其是在有经验的手中,在术中失血方面也优于开放入路,术后恢复,和生活质量。85%或更高比例的受访者同意大多数(69.5%)的陈述。然而,证据主要基于回顾性病例对照研究和这些研究的系统评价,明显受选择偏差的影响。此外,迄今为止,尚未发表随机对照试验(RCT),尽管欧洲目前正在进行四项RCT。
LAPS目前正处于开发和勘探阶段,正如国际理想外科创新框架所定义的那样。LDP是可行和安全的,在许多中心表演,而LPD仅限于少数中心。RCT和注册研究对于进行LAPS评估至关重要。