BACKGROUND
Minimally invasive total gastrectomy (MITG) has demonstrated superiority over open surgery for general surgical outcomes and oncological equivalence in patients with gastric cancer. MITG is an advanced laparoscopic operation requiring a high level of technical skill. For oncological indications, key principles of lymphadenectomy of nodal stations and achieving an R0 resection margin must be respected. To standardize clinical outcomes and maintain surgical quality of MITG, there must be a consensus on the key technical steps and surgical technique of the lymphadenectomy and anastomosis creation which are currently lacking.
OBJECTIVE
The aim of this study is to determine an expert consensus from an international panel regarding the technical performance of MITG using a Delphi method.
METHODS
A novel scoping questionnaire will be created based on the deconstruction of MITG into its integral technical steps through local and international expert opinion and literature evidence. Expert surgeons in minimally invasive upper gastrointestinal surgery across the globe will be invited to participate in an online Delphi consensus. The panelists will vote on the issues generated in previous rounds concerning importance, difficulty, or agreement of statements grouped into 4 broad domains of the Delphi. A priori definition of consensus will be set at 80% agreement. Internal consistency and reliability will be evaluated using Cronbach's alpha, and univariate statistics will be undertaken on individual outcome measures. This process will repeat until consensus is reached on all statements and a final guidance can be reported.
RESULTS
The Delphi rounds will deliver necessary consensus statements regarding MITG lymphadenectomy and general aspects of anastomosis creation.
CONCLUSIONS
The results of this study will generate for the first-time, consensus statements regarding the optimal technical steps in performing MITG for oncological indications. It will inform best surgical practices and provide a platform for creating surgical video-assessment tools designed to improve clinical outcomes and standardize surgical quality in MITG.
CLINICALTRIAL
Not applicable