REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer
Authors: Boggi Ugo , Kauffmann Emanuele , Napoli Niccolò , Barreto S. George , Besselink Marc G. , Fusai Giuseppe K , Hackert Thilo , Abu Hilal Mohammad , Marchegiani Giovanni , Salvia Roberto , Shrikhande Shailesh , Truty Mark , Werner Jens , Wolfgang Christopher , Bannone Elisa , Capretti Giovanni , Cattelani Alice , Coppola Alessandro , Cucchetti Alessandro , De Sio Davide , Di Dato Armando , Di Meo Giovanna , Fiorillo Claudio , Gianfaldoni Cesare , Ginesini Michael , Hidalgo Salinas Camila , Lai Quirino , Miccoli Mario , Montorsi Roberto , Pagnanelli Michele , Poli Andrea , Ricci Claudio , Sucameli Francesco , Tamburrino Domenico , Viti Virginia , Addeo Pietro F. , Alfieri Sergio , Bachellier Philippe , Baiocchi Gianluca , Balzano Gianpaolo , Barbarello Linda , Brolese Alberto , Busquets Juli , Butturini Giovanni , Caniglia Fabio , Caputo Damiano , Casadei Riccardo , Chunhua Xi , Colangelo Ettore , Coratti Andrea , Costa Francesca , Crafa Francesco , Dalla Valle Raffaele , De Carlis Luciano , de Wilde Roeland F. , Del Chiaro Marco , Di Benedetto Fabrizio , Di Sebastiano Pierluigi , Domak Safi , Hogg Melissa , Egorov Vyacheslav I. , Ercolani Giorgio , Ettorre Giuseppe Maria , Falconi Massimo , Ferrari Giovanni , Ferrero Alessandro , Filauro Marco , Giardino Alessandro , Grazi Gian Luca , Gruttaduaria Salvatore , Izbicki Jakob R , Jovine Elio , Katz Matthew , Keck Tobias , Khatkov Igor , Kiguchi Gozo , Kooby David , Lang Hauke , Lombardo Carlo , Malleo Giuseppe , Massani Marco , Mazzaferro Vincenzo , Memeo Riccardo , Miao Yi , Mishima Kohei , Molino Carlo , Nagakawa Yuichi , Nakamura Masafumi , Nardo Bruno , Panaro Fabrizio , Pasquali Claudio , Perrone Vittorio , Rangelova Elena , Riu Long , Romagnoli Renato , Romito Raffaele , Rosso Edoardo , Schulick Richard , Siriwardena Ajith , Spampinato Marcello , Strobel Oliver , Testini Mario , Troisi Roberto , Uzunoglo Faik G , Valente Roberto , Veneroni Luigi , Zerbi Alessandro , Vicente Emilio , Vistoli Fabio , Vivarelli Marco , Wakabayashi Go , Zanus Giacomo , Zureikat Amer , Zyromski Nicholas J , Coppola Roberto , D’Andrea Vito , Davide José , Dervenis Christos , Frigerio Isabella , Konlon Kevin C. , Michelassi Fabrizio , Montorsi Marco , Nealon William , Portolani Nazario , Sousa Silva Donzília , Bozzi Giuseppe , Ferrari Viviana , Trivella Maria G , Cameron John , Clavien Pierre-Alain , Asbun Horacio J. ,   Multidisciplinary advisory board
Published: February 2024

Objective:
The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).

Summary Background Data:
Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.

Methods:
The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines.

Results:
Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population (https://rediscover.unipi.it/)

Conclusions:
The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.