TY - JOUR
T1 - REsolution of Symptoms afTer Oesophago-gastric cancer REsection delphi (RESTOREd) - standardizing the definition, investigation and management of gastrointestinal symptoms and conditions after surgery
AU - RESTORE Delphi study group
AU - Byrne, Ben E.
AU - Siaw-Acheampong, Kwabena
AU - Evans, Orla
AU - Taylor, Joanna
AU - Huddy, Fiona
AU - Nilsson, Magnus
AU - Griffiths, Ewen A.
AU - Low, Donald
AU - Gossage, James
AU - Dunn, Jason
AU - Zeki, Sebastian
AU - Markar, Sheraz
AU - Avery, Kerry
AU - Blazeby, Jane M.
AU - Cockbain, Andrew
AU - Moss, Charlotte
AU - Van Hemelrijck, Mieke
AU - Andreyev, Jervoise
AU - Davies, Andrew R.
AU - Allum, W.
AU - Chaudry, A.
AU - Kumar, S.
AU - Muls, A.
AU - Shaw, C.
AU - Baker, C.
AU - Coombes, A.
AU - Kelly, M.
AU - Wong, T.
AU - Beales, I.
AU - Berrisford, R.
AU - Wright, A.
AU - Boger, P.
AU - Bunting, D.
AU - Carter, N.
AU - Mercer, S.
AU - Pucher, P. H.
AU - Robinson, B.
AU - Cheong, E.
AU - Kumar, B.
AU - Cominos, M.
AU - Hill, M.
AU - Waters, J.
AU - Couper, G.
AU - Skipworth, R.
AU - Cowie, A.
AU - Crosby, T.
AU - Dewar, D.
AU - Goh, V.
AU - Lagergren, J.
AU - Subesinghe, M.
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - Background: Oesophago-gastric cancer surgery negatively affects quality of life with a high postoperative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. This study aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients. Method: Modified two-round Delphi consensus study of a multidisciplinary expert panel. Results: Eighty-six of 127 (67.7%) and 77 of 93 (82.8%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first- and second-line investigation and first-line treatments were agreed. Consensus was not reached for third-line investigation of some conditions, or for second-, third- or fourth-line treatments for others. Twelve of 14 (85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (<1 year) and late (>1 year) postoperative periods. Conclusion: Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This may allow standardization and timely diagnosis and treatment of postoperative conditions, reducing variation in care and optimizing patients' quality of life.
AB - Background: Oesophago-gastric cancer surgery negatively affects quality of life with a high postoperative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. This study aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients. Method: Modified two-round Delphi consensus study of a multidisciplinary expert panel. Results: Eighty-six of 127 (67.7%) and 77 of 93 (82.8%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first- and second-line investigation and first-line treatments were agreed. Consensus was not reached for third-line investigation of some conditions, or for second-, third- or fourth-line treatments for others. Twelve of 14 (85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (<1 year) and late (>1 year) postoperative periods. Conclusion: Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This may allow standardization and timely diagnosis and treatment of postoperative conditions, reducing variation in care and optimizing patients' quality of life.
UR - http://www.scopus.com/inward/record.url?scp=85212244884&partnerID=8YFLogxK
U2 - 10.1093/bjs/znae286
DO - 10.1093/bjs/znae286
M3 - Article
C2 - 39657739
AN - SCOPUS:85212244884
SN - 0007-1323
VL - 111
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 12
M1 - znae286
ER -
