Journal of Visceral Surgery最新文献

Aim of the study

Mean corpuscular volume (MCV) has shown mounting evidence as a prognostic indicator in a number of malignancies. The aim of this study was to examine the prognostic potential of pretherapeutic MCV among patients with pancreatic ductal adenocarcinoma (PDAC) who underwent upfront resection or resection after neoadjuvant treatment (NT).

Patients and methods

Consecutive patients with PDAC who underwent pancreatic resection between 1997 and 2019 were included in this study. Neoadjuvantly treated patients’ serum MCV was measured before NT and before surgery. In patients undergoing upfront resection serum MCV was measured before surgery. Median MCV values were used as cut-off to distinguish high from low MCV values.

Results

Five hundred and forty-nine (438 upfront resected and 111 neoadjuvantly treated) patients were included in this study. Multivariate analysis revealed, that high MCV before and after NT, were independent negative prognostic factors for overall survival (P < 0.01, respectively). Furthermore, the median MCV value from before to after NT increased significantly (P < 0.001, Wilcoxon signed-rank test) and was (P = 0.03, Wilcoxon rank sum test) associated with tumor response to NT.

Conclusion

High MCV is an independent adverse prognostic factor in patients with resectable neoadjuvantly treated PDAC and may qualify as useful indicator to help physicians to provide personalized prognostication.

Objective

Environmental factors contribute to more than 25% of all global disease but as medical student, we consider that environmental health is insufficiently taught. We are not armed for facing patient's questions, prevent diseases linked to environmental exposure and adapt care in susceptible population.

Material and methods

We conducted a national French survey, using a web-based questionnaire from October to November 2021. All medical students were interrogated to assess their knowledge on environmental health and their desire to obtain a specific curriculum on this topic.

Results

Two hundred and thirty-two students responded to the survey and most (62.7%) had never had any teaching on environmental health during their medical studies. The majority claimed to have no knowledge on environmental health (63.6%), and most had never been read or seen media content about it (59.2%). Those who had knowledge on environmental health, had been informed through social media, questioning the reliability of this content. Most (87.3%) were ready to take a specific course on environmental health issues during their medical studies in order to better inform their patients with evidence-based medicine and identify at risk population.

Conclusion

Through a survey, we identified the need and the emergency of implanting a curriculum on environmental medicine in our medical education.

Introduction

The objective of this systematic review of the literature is to compare a selection of currently utilized disposable and reusable laparoscopic medical devices in terms of safety (1st criteria), cost and carbon footprint.

Material and methods

A search was carried out on electronic databases for articles published up until 6 May 2022. The eligible works were prospective (randomized or not) or retrospective clinical or medical-economic comparative studies having compared disposable scissors, trocars, and mechanical endoscopic staplers to the same instruments in reusable. Two different independent examiners extracted the relevant data.

Results

Among the 2882 articles found, 156 abstracts were retained for examination. After comprehensive analysis concerning the safety and effectiveness of the instruments, we included four articles. A study on trocars highlighted increased vascular complications with disposable instruments, and another study found more perioperative incidents with a hybrid stapler as opposed to a disposable stapler. As regards cost analysis, we included 11 studies, all of which showed significantly higher costs with disposable instruments.

The results of the one study on carbon footprints showed that hybrid instruments leave four times less of a carbon footprint than disposable instruments.

Conclusion

The literature on the theme remains extremely limited. Our review demonstrated that from a medical and economic standpoint, reusable medical instruments, particularly trocars, presented appreciable advantages. While there exist few data on the ecological impact, those that do exist are unmistakably favorable to reusable instruments.

Introduction

Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location.

Method

The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery versus laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis “meta” version 6.5-0.

Results

Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (n = 1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR = 0.48 [0.24–0.95], p = 0.04, I² = 0%), and a longer operative time for RS (mean difference = 39.11 min [9.39–68.83], p < 0.01, I² = 96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5 hours earlier after RS), and lymph node dissection (one more lymph node for LS).

Conclusion

This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.

In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.

Healthcare sectors, particularly operating theaters, are major consumers of resources. Given today's climate-related issues, its seems vital that the different healthcare professionals in operating areas become aware of their roles. This is pronouncedly the case for hospital pharmacists, who fulfill cross-sectional functions in the proper use and management of healthcare products and sterile medical devices. The objective of this review of the literature is to identify the actions a hospital pharmacist can take to impel evolution toward ecologically responsible care in the operating theater. Seven areas in which a pharmacist can assume a leading, supporting or composite role in rendering an operating theater ecologically responsible have been highlighted: purchasing, procurement and storage, harmonization of practices, modification of practices, professional attire, waste elimination and research/teaching. The active participation of all healthcare professionals, including the hospital pharmacist, is essential to the development of a sustainable approach to healthcare.