Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

TIME TRENDS IN THE TREATMENT AND PROGNOSIS OF RESECTABLE PANCREATIC CANCER IN A LARGE TERTIARY REFERRAL CENTRE

Background: La mortalit\ue0 per cancro del pancreas \ue8 rimasta sostanzialmente costante negli ultimi decenni. Lo scopo del presente studio \ue8 quello di analizzare le tendenze di sopravvivenza in una popolazione selezionata di pazienti affetti da carcinoma pancreatico resecato in una singola istituzione. Metodi: Nello studio sono stati inclusi 544 pazienti sottoposti a pancreasectomia per cancro al pancreas nel nostro istituto tra 1990-2009. I pazienti sono stati classificati in base alla decade i cui sono stati resecati (1990-1999 e 2000-2009). I fattori predittori di sopravvivenza sono stati analizzati mediante l'analisi univariata e multivariata. Risultati: Sono stateeseguite 114 (21%) resezioni nel periodo 1990-1999 e 430 (79%) nel periodo 2000-2008 (p <0.0001). La durata della degenza ospedaliera (LOS) (16 giorni contro 10 giorni, p <0,001) e la mortalit\ue0 postoperatoria (2,6% verso 1,1%, p = 0.16) sono diminuite nel corso del tempo. La mediana di sopravvivenza malattia-specifica (DSS) \ue8 significativamente aumentata da 16 mesi nel primo periodo a 29 mesi nel secondo periodo (P <0,0001). All'analisi multivariata, le neoplasie meno differenziate (HR = 3.1, p <0.0001), la presenza di metastasi linfonodali (HR = 1.9, p <0.0001), le resezione R2 (HR 3,2 p <0,0001), l'assenza di una terapia adiuvante (HR = 1.6, p <0.001) e la resezione effettuata durante il periodo 1990-2000 (HR 2.18, p <0.0001) sono risultati predittori indipendenti di prognosi sfavorevole. Conclusioni: La sopravvivenza a lungo termine dopo resezione ad intento curativo per il carcinoma pancreatico \ue8 notevolmente migliorata nel tempo. Una pi\uf9 accurata selezione dei pazienti, una diminuzione della mortalit\ue0 post-operatoria e l'uso abituale di una terapia adiuvante pu\uf2 giustificare questo miglioramento .Background: Mortality for pancreatic cancer has remained unchanged over the last 20-30 years. The aim of the present study was to analyze the survival trends in a selected population of patients who underwent resection for pancreatic cancer at a single institution. Methods: Included were 544 patients who underwent pancreatectomy for pancreatic cancer between 1990-2009. Patients were categorized into two subgroups according to the decade in which resection was performed (1990-1999 and 2000-2009). Predictors of survival were analyzed by univariate and multivariate analysis. Results: There were 114 (21%) resections in the period 1990-1999 and 430 (79%) in the period 2000-2009 (P<0.0001). The length of hospital of stay (LOS) (16 days versus 10 days, P < 0.001) and the postoperative mortality (2.6% versus 1.1%, P = 0.160) decreased over time. The median disease-specific survival (DSS) significantly increased from 16 months in the first period to 29 months in the second period (P< 0.001). Following multivariable analysis, poorly differentiated tumour (HR = 3.1, P<0.001), lymphnode metastases (HR = 1.9, P< 0.001), R2 resection (HR 3.2 P< 0.0001), no adjuvant therapy (HR 1.6, P<0.001) and the resection performed in the period 1990-1999 (HR 2.18, P<0.001) were significant independent predictors of poor outcome. Conclusions: Long-term survival after surgery for resected pancreatic cancer significantly improved over the time. Improved patient selection and the routine case use of adjuvant therapy may account for this improvement

Is CA 19-9 a screening marker?

CA 19-9 a screening marke

The role of splenectomy in myelofibrosis with myeloid metaplasia

Aim. In this paper we retrospectively analyzed prospectively-collected data on our myelofibrosis with myeloid metaplasia (MMM) patients who underwent splenectomy. The aim was to ascertain the hematological response and any resolution of symptoms existing prior to splenectomy; redefining timing and role of splenectomy in the treatment of MMM. Methods. This prospective study considered 31 patients with MMM who underwent splenectomy for transfusion-dependent anemia, thrombocytopenia, abdominal swelling and pain. Postoperative work-up consisting in laboratory tests and clinical evaluation performing a quality of life (QoL) test based on EORTC QLQ-C30 questionnaire. Follow-up data were collected for one year after surgery. Statistical analysis used Student's t-test, the Mann-Whitney rank sum, Fisher's exact test, the Friedman test and the Wilcoxon test. Results. Mortality was 3.2%. Respiratory symptomatic complications occurred in 35.4%. In all patients the need for blood transfusions was significantly reduced (P=0.005). An improvement in the painful symptoms was reported and a significant improve of postoperative quality of life was observed at one year after surgery. Conclusion. In our experience splenectomy is associated with limited perioperative mortality and morbidity. Acute complications are almost exclusively limited to respiratory tract. The removal of spleen seems can be recommended to increase the QoL and to palliate hematological disorders in patients no more responder to chemotherapy

Trattamento degli aneurismi del tronco celiaco.

Celiac trunk aneurysms, represent about 4%, of all splanchnie aneurysms. They are rare lesions but clinically important because when ruptured are associated with high mortality. We report our experience in the treatment of 3 patients affected by aneurysms involving the celiac trunk, 2 females and1 male, with a median age of 55.3 years (37 - 74). Two were treated surgically and one percutaneously. Based on the Literature data and on personal experience, we suggest that the first diagnostic approach can be echography, while CT scan and angiography improve definition of the lesion and (if they are) of the anatomic anomalies. Concerning treatment, the first choice should be traditional surgery and percutaneous treatment should be reserved to high risk patients