Surgical Management of Soft Tissue Sarcoma

Background: To study the management patternof soft tissue sarcomas in a tertiary care settingMethods: In this descriptive study patients whowere operated for soft tissue masses were included.Intra-operative findings, procedure details andpostoperative orders were recorded. Postoperativechemo-radiotherapy records were reviewed andrecorded. Depth of the tumour was grouped asdeeper or superficial than 5 cm. The follow uprecords were accessed from the outpatientdepartment and any surgical complications wererecorded up to three years.Staging was done usingclinical and radiological criteria taking into accountthe histological grade,tumour size , depth, locallymph node invasion and metastasis.Surgicalprocedure for removal of STS are wide local excision(WLE), intralesional excision (IE) or tumordebulking, marginal excision (ME) and radicalexcision (RE).Results: Sixty eight patients with mean age of 43.0± 17.258 SD were diagnosed as cases of soft tissuesarcomas. Male to female ratio was 3.25:1.The mostcommon histopathological variety was malignantfibrous histiocytoma (35.3%) , followed byRhabdomyosarcoma(30%). Most common involvedsite was lower limbs (35.3%).Wide local excision wasperformed in majority (82.4%) . Most commonpostop complication was wound infection (10.3%)Conclusion: Clinicians must be agile about thenature of these tumours and their referral to aspecialist surgeon for further management. Promptdiagnosis, accurate investigations and earlyintervention will benefit the patients and help usunderstand this disease entity

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