How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

A current perspective on treatment of adrenocortical carcinoma

Introduction: Adrenocortical carcinoma (ACC) is an aggressive tumor with a short life expectancy and severe impact on quality of life. Due to the rarity of ACC progress in the development of treatment options beyond surgery has been limited.Areas covered: Postoperative treatment with mitotane for adjuvant purposes is currently recommended in many expert centers for patients at elevated risk of recurrence. Lacking data from prospective trials, evidence in favor of adjuvant mitotane comes from retrospective studies that have shown a benefit in recurrence-free survival in treated patients. The management of patients with recurrent and metastatic disease is challenging and the prognosis is often poor. Mitotane monotherapy may be used in patients with a low tumor burden and/or less aggressive disease, while cytotoxic chemotherapy is the treatment of choice for progressing tumors. No effective target therapy emerged from preclinical studies.Expert opinion: At our center, adjuvant mitotane treatment is recommended in all patients bearing ACC at high risk of recurrence. Patients with low-risk tumors are encouraged to enter the ADIUVO trial. A monitored mitotane approach is used trying to reach and maintain a mitotane level of 14-20 mg/l. For treatment of advanced ACC, patients are stratified according to their prognostic factors and consequently apply mitotane or mitotane plus etoposide, doxorubicin and cisplatin. In a number of patients, who are elderly or present with impaired clinical conditions, a simplified scheme with mitotane and cisplatin was chosen