265 An International Delphi Consensus for Surgical Quality Assessment of Lymphadenectomy and Anastomosis in Minimally Invasive Total Gastrectomy for Gastric Cancer

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Abstract Background Minimally invasive total gastrectomy (MITG) is an established curative approach for gastric cancer. However, variability in technique—particularly regarding lymphadenectomy and anastomosis creation—limits standardisation and optimisation of surgical outcomes. Establishing expert consensus on key technical steps is essential to guide practice, benchmark surgery, and improve quality. Aim To establish expert consensus on the technical components of MITG for oncological indications. Method A 100-point scoping survey was created by deconstructing MITG into key technical steps based on literature review and expert input. A Delphi process was conducted with an international panel of high-volume oesophagogastric and general surgeons. Panellists rated items based on importance, difficulty, and agreement via online questionnaires. Consensus was defined a priori as >80% agreement. Internal consistency was assessed using Cronbach’s α. Results Thirty expert surgeons participated in three Delphi rounds, achieving final consensus on 41 statements defining technical standards for MITG. Consensus was reached from 22, 12, and 7 questions across rounds 1, 2, and 3, respectively. Statements addressed critical aspects of lymphadenectomy, reconstruction, and intraoperative decision-making. Cronbach’s α for lymphadenectomy and anastomosis steps was 0.90 and 0.89 in round 1, and 0.85 and 0.78 in round 2, indicating strong internal consistency. Five questions regarding the importance of specific MITG steps and three binary-response questions on anastomosis creation did not reach consensus after three rounds. Conclusions This is the first international Delphi consensus on technical steps in MITG. The 41 statements provide a foundation for developing surgical quality assessment tools to standardise technique, enable benchmarking, and improved outcomes from MITG.

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