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BJS Open
BJS Open
bjsopen
BJS Open
2474-9842
Oxford University Press UK

10.1093/bjsopen/zrae106
zrae106
Research Letter
AcademicSubjects/MED00910
Bjs/3
Research priorities in pancreatic surgery
https://orcid.org/0009-0004-3771-6245
Holze Magdalena Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
Study Centre of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany

Zlatopolskaia Anna Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
Study Centre of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany

Pianka Frank Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
Study Centre of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany

https://orcid.org/0000-0001-6145-3263
Pausch Thomas Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany

Diener Markus K Study Centre of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany
Department of General, Visceral and Thoracic Surgery, Klinikum Nürnberg, Nürnberg, Germany

Antony Pia Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland

Loos Martin Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany

Michalski Christoph W Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany

https://orcid.org/0000-0003-4123-261X
Klotz Rosa Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
Study Centre of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany

Probst Pascal Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland

Correspondence to: Magdalena Holze, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg, 69120, Germany (e-mail: magdalena.holze@med.uni-heidelberg.de; @MagdalenaHolze)
Presented to: the annual meeting of the German Congress of Surgery, Munich, Germany, April 2023; the annual meeting of the Swiss College of Surgeons, Basel, Switzerland, June 2023; and the annual meeting of the German Pancreas Club, Bonn, Germany, February 2024.

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© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.
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pmcThough magnificent technical and perioperative improvements have been made in the past decade, research in the field of pancreatic surgery continuously offers multiple opportunities for further approaches to reduce mortality and minimize the risk of potentially life-threatening complications. This is evident in the increasing quantity and improving quality of published randomized clinical trials (RCTs) on this topic1. Over the past decade, there has been an almost three-fold rise in the number of new publications per year dedicated to this topic, leading to a massive increase in available information and new data. As there are still evidence gaps that need to be addressed in pancreatic surgery research, the International Study Group of Pancreatic Surgery (ISGPS) developed the Evidence Map of Pancreatic Surgery (www.EVIglance.com) to provide a high-quality and readily accessible overview of the current evidence with regard to all aspects of pancreatic surgery and moreover to uncover the existing research gaps2.

In times of resource scarcity, research activities should be prioritized according to their clinical and political relevance. To conduct more relevant trials, it is mandatory to identify and prioritize the most important research topics and research gaps. The aim of the present survey was to list existing deficiencies in evidence and furthermore set priorities in the field of pancreatic surgery for future research projects.

Based on the Evidence Map of Pancreatic Surgery, a survey was conducted among international pancreatic societies to assess priorities for all topics in the field of pancreatic surgery and to also rank the existing evidence gaps. Pancreatic surgeons were asked to rate their ‘top 5’ research topics from all 76 topics from the Evidence Map of Pancreatic Surgery. Additionally, they evaluated the importance of having an RCT for the existing evidence gaps.

From January to July 2022, 149 pancreatic surgeons from 30 countries contributed to this survey. The majority were European, working in a university hospital, and had more than 12 years of surgical expertise (Table S1).

Of 76 topics covering the field of pancreatic surgery, the participants selected their top five research interests, which were compiled into a top ten list (Table 1). The topic ranked first was ‘vascular resection in pancreatic surgery’, with 27.3% of the votes. The topic ranked second was ‘radical antegrade modular pancreatosplenectomy (RAMPS) versus standard distal pancreatectomy’, with 21.0% of the votes. Both ‘time point of surgery for chronic pancreatitis’ and ‘coeliac axis resection in distal pancreatectomy’ were ranked third, with each of these topics receiving 18.9% of the votes. See Table S2 for the full list.

Table 1 Top ten research priorities

Topic	Votes	
1. Vascular resection in pancreatic surgery	39 (27.3)	
2. Radical antegrade modular pancreatosplenectomy versus standard distal pancreatectomy	30 (21.0)	
3. Time point of surgery for chronic pancreatitis	27 (18.9)	
4. Coeliac axis resection in distal pancreatectomy	27 (18.9)	
5. Resection versus non-surgical management of pancreatic neuroendocrine tumours	26 (18.2)	
6. Spleen management in distal pancreatectomy	26 (18.2)	
7. Extended versus standard lymphadenectomy in partial pancreatoduodenectomy	24 (16.8)	
8. Multivisceral resection in pancreatic surgery	22 (15.4)	
9. Treatment of complications after pancreatic surgery	21 (14.7)	
10. Minimally invasive versus open distal pancreatectomy	21 (14.7)	
Values are n (%).

The topics ‘resection versus non-surgical management of neuroendocrine pancreatic tumours’ and ‘total versus partial pancreatoduodenectomy’ were ranked first and second with regard to evidence gaps, closely followed by ‘frozen section analysis during pancreatic surgery’ (Table S3).

The existing evidence gaps received high research prioritization among pancreatic surgeons, evident in the top ten list, and several much-needed trials are already underway on various topics. The TETRIS trial3 aims to compare total versus partial pancreatoduodenectomy in high-risk patients, addressing the evidence gap ranked second. Three trials are currently recruiting patients, including the ISOP-DP trial4, all investigating the potential oncological benefits of the RAMPS approach.

The majority of the research priorities identified in this survey pertain to the radicality of pancreatic surgery, including vascular resection and the performance of RAMPS, both of which aim to enhance R0 resection rates and thus improve oncological outcomes.

This prioritization could lead researchers to carry out more targeted and efficient research overall.

Supplementary Material

zrae106_Supplementary_Data

Funding

The authors have no funding to declare.

Disclosure

After conduct of this study, P.P. founded the company EVIglance Inc. (www.EVIglance.com), providing software services for researchers to produce their own evidence maps. The authors declare no other conflict of interest.

Supplementary material

Supplementary material is available at BJS Open online.

Data availability

Data that support the conclusion of the manuscript are included in the Supplementary material. Further data will be shared with other researchers on reasonable request.

Author contributions

Magdalena Holze (Conceptualization, Formal analysis, Methodology, Project administration, Writing—original draft), Anna Zlatopolskaia (Data curation, Formal analysis), Frank Pianka (Writing—review & editing), Thomas Pausch (Conceptualization, Data curation, Investigation, Project administration, Writing—review & editing), Markus K. Diener (Supervision, Writing—review & editing), Pia Antony (Writing—review & editing), Martin Loos (Supervision, Writing—review & editing), Christoph W. Michalski (Project administration, Supervision, Validation, Writing—review & editing), Rosa Klotz (Conceptualization, Project administration, Writing—original draft, Writing—review & editing), and Pascal Probst (Conceptualization, Methodology, Project administration, Supervision, Writing—review & editing)
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References

1 Hüttner  FJ, Capdeville  L, Pianka  F, Ulrich  A, Hackert  T, Büchler  MW  et al  Systematic review of the quantity and quality of randomized clinical trials in pancreatic surgery. Br J Surg  2019;106 :23–31 30582642
2 Probst  P, Hüttner  FJ, Meydan  O, Abu Hilal  M, Adham  M, Barreto  SG  et al  Evidence Map of Pancreatic Surgery–a living systematic review with meta-analyses by the International Study Group of Pancreatic Surgery (ISGPS). Surgery  2021;170 :1517–1524 34187695
3 Azienda Ospedaliera Universitaria Integrata Verona . Total Pancreatectomy vs High-Risk Pancreatic Anastomosis (TETRIS). https://classic.clinicaltrials.gov/ct2/show/NCT05212350 (accessed 10 April 2024)
4 Okada  KI, Kawai  M, Hirono  S, Sho  M, Tani  M, Matsumoto  I  et al  ISOlation Procedure vs. conventional procedure during Distal Pancreatectomy (ISOP-DP trial): study protocol for a randomized controlled trial. Trials  2021;22 :633 34530885
