Raising the bar: evaluating quality and consistency in clinical guidelines for surgical management of pulmonary carcinoid

Abstract

Leading societies have established guidelines that vary significantly regarding recommendations for the surgical management of pulmonary carcinoids (PC). We aimed to assess current guidelines and recommendations for PC surgical management, benchmark their methodological quality, and identify factors that may influence their effectiveness in guiding surgical practice. Literature was sought to identify relevant guidelines for the management of PC. Each guideline was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and rated on a seven-point scale for items and domains. Five observers assessed four guidelines (developed by ENETS in 2015, ESMO in 2021, NANETS in 2021, and NCCN in 2020). In Scope and Purpose and Stakeholder Involvement, the NCCN guideline achieved the highest score. In Rigor of Development, NANETS and ENETS achieved the highest score. In Clarity of Presentation, ENETS guidelines scored the highest score. For applicability, NCCN received the highest score. All guidelines got the highest score in the Rigor of Development and Clarity of Presentation domains, whereas the Applicability domain received the lowest score. The methodological quality of guidelines on the surgical management of PC varies significantly. The findings underscore the need for future guidelines to prioritize practical implementation in clinical and surgical practice, ensuring that recommendations reflect best practices and effectively meet surgeons' needs. Based on our AGREE II appraisal, the ENETS and ESMO guidelines might be recommended as a model for developing future recommendations and guidelines.

Keywords: AGREE II; guidelines; lung cancer; methodology; neuroendocrine; pulmonary carcinoid.