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

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.

Using Social Media to Engage Knowledge Users in Health Research Priority Setting: Scoping Review

“…Table 2 shows the particular social media strategies used to enhance knowledge user engagement in research priority-setting exercises grouped by platform. Of studies using email as their primary social media platform [ 12 , 16 , 17 , 19 , 23 , 24 , 27 , 29 , 30 , 33 ] study teams emailed messages with embedded research prioritization survey links (including to researchers’ existing mailing lists) and integrated tell a friend tool in emails to prompt recipients to invite colleagues to participate. Facebook-specific methods to engage stakeholders included embedding survey links within Facebook posts, using the platform’s boosting feature (ie, paid advertisements), and hiring a Facebook advertising specialist.…”

Consequences of anastomotic leaks after minimally invasive esophagectomy: A single-center experience

“…Despite these advantages, the rate of AL between the distal esophagus and gastric conduit remains similar across operative techniques and is a significant source of postoperative morbidity and mortality [ [24] , [25] , [26] ]. Gaining a better understanding of the risk factors associated with AL development, as well as the impact of AL on other post-operative outcomes, may help determine the benefit of preoperative interventions such as nutritional prehabilitation, and guide the use of AL management techniques such as prophylactic intraoperative stenting and omentoplasty [ 27 , 28 ].…”

Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers

“…The modified Delphi methodology has been described previously. 11 , 12 A 5-stage consensus process was designed for this Delphi exercise, including 2 rounds of voting (Figure 1 ).…”