The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer

Francisco Tustumi; Lucia Calthorpe; Nora Fotoohi; Thiago Costa Ribeiro; Lucas Cata Preta Stolzemburg; Andre L Bettiati Junior; Caroline de Almeida Gonçalves; Ana P Cursino Briet de Almeida; Allana M Gomes Giordano; André Luís de Godoy; Dante Altenfelder; Julia Nicioli; Alexandre C Guimarães; Alejandro S Requejo; Alessandro Landskron Diniz; Alexandre Ferreira Oliveira; Alice C Wei; André de Moricz; Andre L Montagnini; Brendan C Visser; Carlos H F Chan; Cássio V Cavalcante de Oliveira; Cristina R Ferrone; Domenech Asbun; Eduard Jonas; Eduardo J B Ramos; Felix Nickel; Filipe Kunzler de Oliveira Maia; Franz Robert Apodaca-Torrez; Savio G Barreto; D Brock Hewitt; Igor Correia de Farias; Isabella Frigerio; Jin-Young Jang; Marciano Anghinoni; Marcio F Boff; Marcos Belotto; Mariano E Giménez; Masafumi Nakamura; Matthew H G Katz; Melissa E Hogg; Michael L Kendrick; Misha D P Luyer; Mohammad Abu Hilal; Naruhiko Ikoma; Nicholas J Zyromski; Nicolás Jarufe; Oscar A Guevara; Oscar Mazza; Patricio M Polanco; Paulo Cezar G Amaral; Rodrigo Nascimento Pinheiro; D Rohan Jeyarajah; Sebastien Gaujoux; Shailesh V Shrikhande; Silvio M Torres; Ajith K Siriwardena; Tara S Kent; Thilo Hackert; Timothy M Pawlik; Wellington Andraus; Ugo Boggi; Horacio J Asbun; Adnan Alseidi; Felipe José Fernández Coimbra

doi:10.1016/j.hpb.2025.11.012

The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer

Francisco Tustumi
, Lucia Calthorpe
, Nora Fotoohi
, Thiago Costa Ribeiro
, Lucas Cata Preta Stolzemburg
, Andre L Bettiati Junior
, Caroline de Almeida Gonçalves
, Ana P Cursino Briet de Almeida
, Allana M Gomes Giordano
, André Luís de Godoy
, Dante Altenfelder
, Julia Nicioli
, Alexandre C Guimarães
, Alejandro S Requejo
, Alessandro Landskron Diniz
, Alexandre Ferreira Oliveira
, Alice C Wei
, André de Moricz
, Andre L Montagnini
, Brendan C Visser

Carlos H F Chan, Cássio V Cavalcante de Oliveira, Cristina R Ferrone, Domenech Asbun, Eduard Jonas, Eduardo J B Ramos, Felix Nickel, Filipe Kunzler de Oliveira Maia, Franz Robert Apodaca-Torrez, Savio G Barreto, D Brock Hewitt, Igor Correia de Farias, Isabella Frigerio, Jin-Young Jang, Marciano Anghinoni, Marcio F Boff, Marcos Belotto, Mariano E Giménez, Masafumi Nakamura, Matthew H G Katz, Melissa E Hogg, Michael L Kendrick, Misha D P Luyer, Mohammad Abu Hilal, Naruhiko Ikoma, Nicholas J Zyromski, Nicolás Jarufe, Oscar A Guevara, Oscar Mazza, Patricio M Polanco, Paulo Cezar G Amaral, Rodrigo Nascimento Pinheiro, D Rohan Jeyarajah, Sebastien Gaujoux, Shailesh V Shrikhande, Silvio M Torres, Ajith K Siriwardena, Tara S Kent, Thilo Hackert, Timothy M Pawlik, Wellington Andraus, Ugo Boggi, Horacio J Asbun, Adnan Alseidi, Felipe José Fernández Coimbra

Miami Cancer Institute

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.

METHODS: A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.

RESULTS: From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.

DISCUSSION: The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.

Original language	English
Journal	HPB : the official journal of the International Hepato Pancreato Biliary Association
DOIs	https://doi.org/10.1016/j.hpb.2025.11.012
State	E-pub ahead of print - Nov 22 2025

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10.1016/j.hpb.2025.11.012

Cite this

Tustumi, F., Calthorpe, L., Fotoohi, N., Ribeiro, T. C., Stolzemburg, L. C. P., Bettiati Junior, A. L., Gonçalves, C. D. A., de Almeida, A. P. C. B., Giordano, A. M. G., de Godoy, A. L., Altenfelder, D., Nicioli, J., Guimarães, A. C., Requejo, A. S., Diniz, A. L., Oliveira, A. F., Wei, A. C., de Moricz, A., Montagnini, A. L., ... Coimbra, F. J. F. (2025). The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer. HPB : the official journal of the International Hepato Pancreato Biliary Association. Advance online publication. https://doi.org/10.1016/j.hpb.2025.11.012

Tustumi, F, Calthorpe, L, Fotoohi, N, Ribeiro, TC, Stolzemburg, LCP, Bettiati Junior, AL, Gonçalves, CDA, de Almeida, APCB, Giordano, AMG, de Godoy, AL, Altenfelder, D, Nicioli, J, Guimarães, AC, Requejo, AS, Diniz, AL, Oliveira, AF, Wei, AC, de Moricz, A, Montagnini, AL, Visser, BC, Chan, CHF, de Oliveira, CVC, Ferrone, CR, Asbun, D, Jonas, E, Ramos, EJB, Nickel, F, Maia, FKDO, Apodaca-Torrez, FR, Barreto, SG, Hewitt, DB, de Farias, IC, Frigerio, I, Jang, J-Y, Anghinoni, M, Boff, MF, Belotto, M, Giménez, ME, Nakamura, M, Katz, MHG, Hogg, ME, Kendrick, ML, Luyer, MDP, Abu Hilal, M, Ikoma, N, Zyromski, NJ, Jarufe, N, Guevara, OA, Mazza, O, Polanco, PM, Amaral, PCG, Pinheiro, RN, Jeyarajah, DR, Gaujoux, S, Shrikhande, SV, Torres, SM, Siriwardena, AK, Kent, TS, Hackert, T, Pawlik, TM, Andraus, W, Boggi, U, Asbun, HJ, Alseidi, A & Coimbra, FJF 2025, 'The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer', HPB : the official journal of the International Hepato Pancreato Biliary Association. https://doi.org/10.1016/j.hpb.2025.11.012

@article{543166f7f7d34a1a8f1041ee1df4abd6,

title = "The S{\~a}o Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer",

abstract = "BACKGROUND: Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the S{\~a}o Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.METHODS: A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 \% agreement.RESULTS: From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 \% agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.DISCUSSION: The S{\~a}o Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.",

author = "Francisco Tustumi and Lucia Calthorpe and Nora Fotoohi and Ribeiro, \{Thiago Costa\} and Stolzemburg, \{Lucas Cata Preta\} and \{Bettiati Junior\}, \{Andre L\} and Gon{\c c}alves, \{Caroline de Almeida\} and \{de Almeida\}, \{Ana P Cursino Briet\} and Giordano, \{Allana M Gomes\} and \{de Godoy\}, \{Andr{\'e} Lu{\'i}s\} and Dante Altenfelder and Julia Nicioli and Guimar{\~a}es, \{Alexandre C\} and Requejo, \{Alejandro S\} and Diniz, \{Alessandro Landskron\} and Oliveira, \{Alexandre Ferreira\} and Wei, \{Alice C\} and \{de Moricz\}, Andr{\'e} and Montagnini, \{Andre L\} and Visser, \{Brendan C\} and Chan, \{Carlos H F\} and \{de Oliveira\}, \{C{\'a}ssio V Cavalcante\} and Ferrone, \{Cristina R\} and Domenech Asbun and Eduard Jonas and Ramos, \{Eduardo J B\} and Felix Nickel and Maia, \{Filipe Kunzler de Oliveira\} and Apodaca-Torrez, \{Franz Robert\} and Barreto, \{Savio G\} and Hewitt, \{D Brock\} and \{de Farias\}, \{Igor Correia\} and Isabella Frigerio and Jin-Young Jang and Marciano Anghinoni and Boff, \{Marcio F\} and Marcos Belotto and Gim{\'e}nez, \{Mariano E\} and Masafumi Nakamura and Katz, \{Matthew H G\} and Hogg, \{Melissa E\} and Kendrick, \{Michael L\} and Luyer, \{Misha D P\} and \{Abu Hilal\}, Mohammad and Naruhiko Ikoma and Zyromski, \{Nicholas J\} and Nicol{\'a}s Jarufe and Guevara, \{Oscar A\} and Oscar Mazza and Polanco, \{Patricio M\} and Amaral, \{Paulo Cezar G\} and Pinheiro, \{Rodrigo Nascimento\} and Jeyarajah, \{D Rohan\} and Sebastien Gaujoux and Shrikhande, \{Shailesh V\} and Torres, \{Silvio M\} and Siriwardena, \{Ajith K\} and Kent, \{Tara S\} and Thilo Hackert and Pawlik, \{Timothy M\} and Wellington Andraus and Ugo Boggi and Asbun, \{Horacio J\} and Adnan Alseidi and Coimbra, \{Felipe Jos{\'e} Fern{\'a}ndez\}",

year = "2025",

month = nov,

day = "22",

doi = "10.1016/j.hpb.2025.11.012",

language = "English",

journal = "HPB : the official journal of the International Hepato Pancreato Biliary Association",

issn = "1365-182X",

}

TY - JOUR

T1 - The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer

AU - Tustumi, Francisco

AU - Calthorpe, Lucia

AU - Fotoohi, Nora

AU - Ribeiro, Thiago Costa

AU - Stolzemburg, Lucas Cata Preta

AU - Bettiati Junior, Andre L

AU - Gonçalves, Caroline de Almeida

AU - de Almeida, Ana P Cursino Briet

AU - Giordano, Allana M Gomes

AU - de Godoy, André Luís

AU - Altenfelder, Dante

AU - Nicioli, Julia

AU - Guimarães, Alexandre C

AU - Requejo, Alejandro S

AU - Diniz, Alessandro Landskron

AU - Oliveira, Alexandre Ferreira

AU - Wei, Alice C

AU - de Moricz, André

AU - Montagnini, Andre L

AU - Visser, Brendan C

AU - Chan, Carlos H F

AU - de Oliveira, Cássio V Cavalcante

AU - Ferrone, Cristina R

AU - Asbun, Domenech

AU - Jonas, Eduard

AU - Ramos, Eduardo J B

AU - Nickel, Felix

AU - Maia, Filipe Kunzler de Oliveira

AU - Apodaca-Torrez, Franz Robert

AU - Barreto, Savio G

AU - Hewitt, D Brock

AU - de Farias, Igor Correia

AU - Frigerio, Isabella

AU - Jang, Jin-Young

AU - Anghinoni, Marciano

AU - Boff, Marcio F

AU - Belotto, Marcos

AU - Giménez, Mariano E

AU - Nakamura, Masafumi

AU - Katz, Matthew H G

AU - Hogg, Melissa E

AU - Kendrick, Michael L

AU - Luyer, Misha D P

AU - Abu Hilal, Mohammad

AU - Ikoma, Naruhiko

AU - Zyromski, Nicholas J

AU - Jarufe, Nicolás

AU - Guevara, Oscar A

AU - Mazza, Oscar

AU - Polanco, Patricio M

AU - Amaral, Paulo Cezar G

AU - Pinheiro, Rodrigo Nascimento

AU - Jeyarajah, D Rohan

AU - Gaujoux, Sebastien

AU - Shrikhande, Shailesh V

AU - Torres, Silvio M

AU - Siriwardena, Ajith K

AU - Kent, Tara S

AU - Hackert, Thilo

AU - Pawlik, Timothy M

AU - Andraus, Wellington

AU - Boggi, Ugo

AU - Asbun, Horacio J

AU - Alseidi, Adnan

AU - Coimbra, Felipe José Fernández

PY - 2025/11/22

Y1 - 2025/11/22

N2 - BACKGROUND: Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.METHODS: A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.RESULTS: From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.DISCUSSION: The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.

AB - BACKGROUND: Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.METHODS: A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.RESULTS: From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.DISCUSSION: The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.

U2 - 10.1016/j.hpb.2025.11.012

DO - 10.1016/j.hpb.2025.11.012

M3 - Article

C2 - 41419350

SN - 1365-182X

JO - HPB : the official journal of the International Hepato Pancreato Biliary Association

JF - HPB : the official journal of the International Hepato Pancreato Biliary Association

ER -