Management of asymptomatic, well-differentiated PNETs

results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association

John C. Mansour, Kenneth Chavin, Gareth Morris-Stiff, Susanne G. Warner, Kenneth Cardona, Zhi V. Fong, Ajay Maker, Steven Libutti, Robert Warren, Charles St. Hill, Scott Celinski, Philippa Newell, Quan P. Ly, James Howe, Natalie Coburn

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs. Methods: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed. Results: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for <1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1–2 cm tumors. Conclusions: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.

Original languageEnglish (US)
Pages (from-to)515-523
Number of pages9
JournalHPB
Volume21
Issue number5
DOIs
StatePublished - May 1 2019

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Primitive Neuroectodermal Tumors
Biopsy
Neoplasms
Pancreatectomy
Splenectomy
Lymph Node Excision
Guidelines
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Hepatology

Cite this

Mansour, J. C., Chavin, K., Morris-Stiff, G., Warner, S. G., Cardona, K., Fong, Z. V., ... Coburn, N. (2019). Management of asymptomatic, well-differentiated PNETs: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association. HPB, 21(5), 515-523. https://doi.org/10.1016/j.hpb.2018.09.020
Mansour, John C. ; Chavin, Kenneth ; Morris-Stiff, Gareth ; Warner, Susanne G. ; Cardona, Kenneth ; Fong, Zhi V. ; Maker, Ajay ; Libutti, Steven ; Warren, Robert ; St. Hill, Charles ; Celinski, Scott ; Newell, Philippa ; Ly, Quan P. ; Howe, James ; Coburn, Natalie. / Management of asymptomatic, well-differentiated PNETs : results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association. In: HPB. 2019 ; Vol. 21, No. 5. pp. 515-523.
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abstract = "Background: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs. Methods: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed. Results: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for <1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1–2 cm tumors. Conclusions: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.",
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Mansour, JC, Chavin, K, Morris-Stiff, G, Warner, SG, Cardona, K, Fong, ZV, Maker, A, Libutti, S, Warren, R, St. Hill, C, Celinski, S, Newell, P, Ly, QP, Howe, J & Coburn, N 2019, 'Management of asymptomatic, well-differentiated PNETs: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association', HPB, vol. 21, no. 5, pp. 515-523. https://doi.org/10.1016/j.hpb.2018.09.020

Management of asymptomatic, well-differentiated PNETs : results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association. / Mansour, John C.; Chavin, Kenneth; Morris-Stiff, Gareth; Warner, Susanne G.; Cardona, Kenneth; Fong, Zhi V.; Maker, Ajay; Libutti, Steven; Warren, Robert; St. Hill, Charles; Celinski, Scott; Newell, Philippa; Ly, Quan P.; Howe, James; Coburn, Natalie.

In: HPB, Vol. 21, No. 5, 01.05.2019, p. 515-523.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Management of asymptomatic, well-differentiated PNETs

T2 - results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association

AU - Mansour, John C.

AU - Chavin, Kenneth

AU - Morris-Stiff, Gareth

AU - Warner, Susanne G.

AU - Cardona, Kenneth

AU - Fong, Zhi V.

AU - Maker, Ajay

AU - Libutti, Steven

AU - Warren, Robert

AU - St. Hill, Charles

AU - Celinski, Scott

AU - Newell, Philippa

AU - Ly, Quan P.

AU - Howe, James

AU - Coburn, Natalie

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs. Methods: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed. Results: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for <1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1–2 cm tumors. Conclusions: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.

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