Table 3.
Summary of key questions and recommendations
| Key question and recommendation | Strength of recommendation | Level of evidence |
|---|---|---|
| KQ 1. Is staging laparoscopy routinely indicated in resectable pancreatic cancer (RPC)? Recommendations: Staging laparoscopy could be considered selectively before laparotomy in patients with RPC. | Conditional | Low |
| KQ 2. Is minimally invasive surgery (MIS) applicable to the patients with RPC? Recommendations: MIS could be performed selectively for the patients with RPC by highly experienced surgeons. | Conditional | Low |
| KQ 3. Is extended lymph node dissection (LND) and nerve plexus dissection necessary during pancreaticoduodenectomy (PD) for the patients with resectable pancreatic head cancer (RPHC)? Recommendations: Extended LND is not recommended for the patients with RPHC. | Not recommend | High |
| KQ 4-1. Is combined portal vein (PV) or superior mesenteric vein (SMV) resection beneficial in patients with pancreatic cancer invading the PV or SMV? Recommendations: PV or SMV resection could be considered if radical resection is possible in patients with pancreatic cancer invading the PV or SMV. | Conditional | Low |
| KQ 4-2. Is superior mesenteric artery (SMA) resection beneficial in patients with pancreatic cancer invading the SMA? Recommendations: SMA resection is not recommended in patients with pancreatic cancer invading the SMA. | Not recommend | Low |
| KQ 4-3. Is distal pancreatectomy with celiac axis resection (DP-CAR) beneficial in patients with pancreatic cancer invading the celiac axis (CA)? Recommendations: DP-CAR could be considered, if radical resection is possible in patients with pancreatic cancer invading the CA. | Conditional | Low |
| KQ 5. Is mesopancreas excision (MpE) beneficial during PD? Recommendations: MpE could be considered to improve the rate of R0 resection for the patients with RPHC | Conditional | Low |
| KQ 6. Is pylorus preserving pancreaticoduodenectomy (PPPD) preferred to PD in RPHC? Recommendations: PPPD is preferred to PD in RPHC. | Conditional | High |
| KQ 7. Is additional pancreas resection necessary in cases of positive pancreatic resection margin in intraoperative frozen biopsy? Recommendations: Additional pancreas resection could be considered if pancreatic resection margin is positive in intraoperative frozen biopsy. | Conditional | Low |
| KQ 8. Is radical antegrade modular pancreatosplenectomy (RAMPS) beneficial in pancreatic body or tail cancer? Recommendations: RAMS could be considered in pancreatic body or tail cancer. | Conditional | Low |
| KQ 9. Is bypass gastrojejunostomy necessary in cases of unresectable pancreatic cancer without gastric outlet obstruction? Recommendations: Bypass gastrojejunostomy is not recommended in patients with unresectable pancreatic cancer without gastric outlet obstruction. | Not recommend | Low |
| KQ 10. Is pancreatectomy beneficial in cases of pancreatic cancer with pathologically proven para-aortic lymph node metastasis in intraoperative frozen biopsy? Recommendations: Recommendation to perform pancreatectomy in cases of pancreatic cancer with pathologically proven para-aortic lymph node metastasis in intraoperative frozen biopsy is withheld. | Inconclusive | Very low |
| KQ 11. Is hepatic resection beneficial in cases of pancreatic cancer with hepatic oligometastasis? Recommendations: Recommendation to perform hepatic resection in cases of pancreatic cancer with hepatic oligometastasis is withheld. | Inconclusive | Very low |
| KQ 12. Is conversion surgery beneficial in cases of locally advanced pancreatic cancer (LAPC)? Recommendations: Conversion surgery after induction chemotherapy could be considered in cases of LAPC. | Conditional | Low |
| KQ13. Is artery first approach in pancreaticoduodenectomy (AFA-PD) beneficial in cases of pancreatic head cancer? Recommendations: Recommendation to perform AFA-PD in cases of pancreatic head cancer is withheld. | Inconclusive | Very low |