REsolution of Symptoms afTer Oesophago-gastric cancer REsection delphi (RESTOREd)—standardizing the definition, investigation and management of gastrointestinal symptoms and conditions after surgery
Authors: Byrne Ben E , Siaw-Acheampong Kwabena , Evans Orla , Taylor Joanna , Huddy Fiona , Nilsson Magnus , Griffiths Ewen A , Low Donald , Gossage James , Dunn Jason , Zeki Sebastian , Markar Sheraz , Avery Kerry , Blazeby Jane M , Cockbain Andrew , Moss Charlotte , van Hemelrijck Mieke , Andreyev Jervoise , Davies Andrew R ,   RESTORE Delphi study group, Allum W , Chaudry A , Kumar S , Muls A , Shaw C , Baker C , Coombes A , Kelly M , Wong T , Beales I , Berrisford R , Wright A , Boger P , Bunting D , Carter N , Mercer S , Pucher P H , Robinson B , Cheong E , Kumar B , Cominos M , Hill M , Waters J , Couper G , Skipworth R , Cowie A , Crosby T , Dewar D , Dhar A , Fanning M , Fleuret C , Forshaw M , Goh V , Griffin N , Sabharwal T , Haboubi H , Hobson A , Immanuel A , Phillips A , Jafari J , Lagergren J , Lander T , Leach S , Lovat L B , Sita-Lumsden A , Maisey N , Ngan S , Qureshi A , Mainie I , Maynard N , Melia W , Warner B , Mohammadi B , Moore A , Noble F , Parsons S , Petty R , Power N , Pritchard D M , Ravi N , Reynolds J , Robb W , Ryan S , Sloan T , Smyth E , Subesinghe M , Sultan J , Sweis R , Trudgill N , Tucker O , Turkington R , Underwood T , Ward L , White C , Whiting J 
Published: December 2024

Abstract

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 (&lt;1 year) and late (&gt;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.