Gavriilidis Paschalis, Askari Alan, Roberts Keith J, Sutcliffe Robert P
Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Upper Gastro-Intestinal Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK.
Hepatobiliary Surg Nutr. 2020 Apr;9(2):126-135. doi: 10.21037/hbsn.2019.09.06.
Cholangiocarcinoma (CC) is the second most common primary liver tumour. High-quality guidelines are essential for effective patient stratification and individualised treatment. This study aimed to appraise the methodological quality of existing guidelines for the resection of CC using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. A systematic search of the literature in Cochrane, PubMed, Google Scholar, and Embase was performed. Assessment of the clinical practice guidelines (CPGs) and consensuses was performed using the AGREE II instrument by four clinicians experienced in surgical practice and the AGREE II appraisal method. Literature searches identified 13 guidelines of highly variable quality according to the AGREE II criteria. The guidelines scored well in certain domains such as scope & purpose (median score across all guidelines; 65%), clarity of presentation (76%), and editorial independence (56%). However, they scored poorly for applicability (13%), rigour of development (30%), and stakeholder involvement (39%). None of the 13 guidelines was recommended universally for use without modification. Overall, the methodological quality of guidelines on the surgical management of CC is poor. Future updates should address and modify shortcomings detected by the AGREE II instrument, thereby facilitating better patient stratification and individualised treatment strategies.
胆管癌（CC）是第二常见的原发性肝癌。高质量的指南对于有效的患者分层和个体化治疗至关重要。本研究旨在使用研究与评价指南（AGREE II）工具评估现有CC切除术指南的方法学质量。我们在Cochrane、PubMed、谷歌学术和Embase中对文献进行了系统检索。由四名具有外科实践经验的临床医生使用AGREE II工具和AGREE II评估方法对临床实践指南（CPG）和共识进行评估。文献检索发现了13项根据AGREE II标准质量差异很大的指南。这些指南在某些领域得分较高。如范围与目的（所有指南的中位数得分；65%）、表述清晰度（76%）和编辑独立性（56%）。然而，它们在适用性（13%）、制定的严谨性（30%）和利益相关者参与度（39%）方面得分较低。这13项指南中没有一项被普遍推荐不经修改即可使用。总体而言，CC手术管理指南的方法学质量较差。未来的更新应解决并修正AGREE II工具发现的不足之处，从而促进更好的患者分层和个体化治疗策略。
