Journal of Visceral Surgery最新文献

The ecological sustainability of the operating room (OR) is a matter of recent interest. The present systematic review aimed to review the current literature assessing the carbon footprint of surgical procedures in different surgical fields. Following to the PRISMA statement checklist, three databases (MEDLINE, EMBASE, Cochrane Library) were searched by independent reviewers, who screened records on title and abstract first, and then on the full text. Risk of bias was evaluated using the MINORS system. Over the 878 articles initially identified, 36 original studies were included. They considered ophthalmologic surgical procedures (30.5%), general/digestive surgery (19.4%), gynecologic procedures (13.9%), orthopedic procedures (8.3%), neurosurgery (5.5%), otolaryngology/head and neck surgery (5.5%), plastic/dermatological surgery (5.5%), and cardiac surgery (2.8%). Despite a great methodological heterogeneity, data showed that a single surgical procedure emits 4–814 kgCO2e, with anesthetic gases and energy consumption representing the largest sources of greenhouse gas emission. Minimally invasive surgical techniques may require more resources than conventional open surgery, particularly for packaging and plastics, energy use, and waste production. Each OR has the potential to produce from 0.2 to 4 kg of waste per case with substantial differences depending on the type of intervention, hospital setting, and geographic area. Overall, the selected studies were found to be of moderate quality. Based on a qualitative synthesis of the available literature, the OR can be targeted by programs and protocols implemented to reduce the carbon footprint and improve the waste stream of the OR.

The climate emergency alarm is resounding. Tasked with caregiving, healthcare facilities are nonetheless responsible for apparently innumerable greenhouse gas emissions. Predominantly atmospheric pollution causes 9 million deaths a year throughout the world. While legislative measures have been taken to favor change in climate-related business practices, the effects of their implementation are far from visible. On a parallel track, caregivers have been coming together and calling into question their practices, the objective being to institute concrete actions leading to reduction of healthcare-related carbon footprint. Not all of these actions have the same ecological impact or ease of implementation. To demonstrate their effectiveness and set the stage for readjustments, the existing initiatives require qualitative assessment and quantitative appraisal. While they demand personal motivation and professional investment, these efforts have a triple impact, at once ecological, economic and related to quality of life. Multidisciplinary teams come together in the pursuit of a common project epitomizing our missions as caregivers; is not that the essence of our presence in hospital?

Purpose of the study

Climate change represents one of the gravest threats to health. Surgical activities mobilize a large number of resources which contribute to increased emission of CO2 and anesthetic gases in the environment. The objective of this study was to assess the level of knowledge of surgeons and the practical stances of healthcare establishments toward sustainable development.

Methods

This was a descriptive cross-sectional study, lasting 2 months. From 1 May 2021 to 30 June 2021, surgeons were asked via an online questionnaire to participate.

Results

A total of 131 out of the 457 contacted surgeons responded. A majority practiced in the private sector, 48.9% knew little about the rules of sustainable development in operating theaters, and 43.5% had an average level. The sustainable development charter was available in only 23% of establishments, while 19% had a sustainable development committee, and specific sustainable development actions were carried out in 27%.

Conclusion

The level of knowledge of surgeons in Île-de-France on sustainable development was low. In general, surgical units were not complying with the rules of good practice on CO₂ reduction. It is necessary to find strategies to reduce the impact of operating theaters on the environment.

Introduction

Curative management of retroperitoneal sarcoma relies on surgery, and complete monoblock resection is one of the main prognostic factors. The goal of this study was to search predictive factors for incomplete resection.

Methods

All patients undergoing surgery for retroperitoneal sarcoma in two University hospitals between 2010 and 202 were included. The main endpoint was incomplete resection (R1 ad R2) after surgery. Secondary analysis was performed where marginal R0 resection was considered as complete. Univariate and multivariable analysis of demographics, radiological, surgical and pathologic criteria were performed. Overall survival, local and distant recurrence were evaluated.

Results

Fifty-eight patients were included in the study. Fifty patients had incomplete resection, of which seven had marginal R0 resection. In multivariable analysis, none of the factors analyzed were associated with incomplete resection. In secondary analysis, undifferentiated liposarcoma histology (OR 12.3, 95% CI [1.416–107.303], P = 0.023) was statistically significantly associated with incomplete resection. Low grade (grade I) histology was predictive of complete resection (OR 0.24, 95% CI [0.060–0.959], P = 0.043). Median follow-up duration was 27 months. Local and distant recurrence rates at three years were 37% and 22.4%, respectively.

Conclusion

In this study, we highlighted several predictive factors for incomplete resection. These factors enable us to define target populations that could most benefit from complementary therapy along with surgery.

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.