Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

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

Διερεύνηση του ρόλου νέων μοριακών προγνωστικών δεικτών στον καρκίνο του παχέος εντέρου βασισμένων στους βιολογικούς μηχανισμούς δράσης των καρκινικών βλαστικών κυττάρων

Σκοπός: Ο καρκίνος του παχέος εντέρου και ορθού είναι ο τρίτος συνηθέστερος καρκίνος και η τέταρτη πιο συχνή αιτία θανάτου παγκοσμίως, αντιπροσωπεύοντας περίπου 1 με 2 εκατομμύρια νέες περιπτώσεις και 600 000 θανάτους ετησίως. Εκτιμάται ότι το 2019 στην Αμερική θα σημειωθούν 51.020 θάνατοι λόγω καρκίνου του παχέος εντέρου και 101.420 ασθενείς θα διαγνωσθούν με τη νόσο. Αν και η θεραπεία στον καρκίνο του παχέος εντέρου έχει βελτιωθεί ουσιαστικά υπάρχει ωστόσο ένα σημαντικό ποσοστό υποτροπών που εν μέρει εξηγείται από την παρουσία καρκινικών κυττάρων στον όγκο με ιδιότητες βλαστικών κυττάρων τα οποία έχουν τη δυνατότητα να διαφεύγουν της επικουρικής θεραπείας. Έτσι το ερευνητικό ενδιαφέρον έχει επικεντρωθεί στην ανεύρεση δεικτών που εκφράζονται στα κύτταρα αυτά και μπορούν να αποτελέσουν θεραπευτικούς στόχους. Η fascin-1 είναι μια πρωτεΐνη σύνδεσης της ακτίνης ενός από τα δομικά συστατικά του κυτταροσκελετού και ρυθμίζει τo δυναμικό προσκόλλησης των μεταναστευτικών κυττάρων. Ο L1CAM είναι μια διαμεμβρανική γλυκοπρωτεΐνη δίκην ανοσοσφαιρίνης του οποίου η έκφραση έχει παρατηρηθεί σε πολλές κακοήθεις νεοπλασίες. Η nectin-1 είναι μόριo κυτταρικής προσκόλλησης που πρόσφατα έχει αποδειχθεί ότι συνεισφέρει ουσιαστικά στον σχηματισμό συνδέσεων μεταξύ κυττάρων αλλά αποτελεί επίσης σημαντικό ρυθμιστή των κυτταρικών δραστηριοτήτων. Σκοπός της παρούσας μελέτης ήταν η μελέτη της έκφρασης των τριών αυτών δεικτών στον καρκίνο του παχέος εντέρου και η κλινική σημασία της έκφρασης τους. Ασθενείς και Μέθοδοι: 111 δείγματα ασθενών με πρωτοπαθή καρκίνο του παχέος εντέρου, εξετάστηκαν μέσω ανοσοϊστοχημείας για την έκφραση της fascin-1, του L1CAM και της nectin-1 και τα αποτελέσματα συσχετίστηκαν με κλινικοπαθολογικά χαρακτηριστικά και δεδομένα επιβίωσης. Αποτελέσματα: Η fascin-1, ο L1CAM και η nectin-1 εμφάνισαν έντονη χρώση στο κυτταρόπλασμα των καρκινικών κυττάρων του παχέος εντέρου. H fascin-1 παρουσίασε επίσης έντονη χρώση στα ενδοθηλιακά κύτταρα των αιμοφόρων αγγείων του όγκου. Μέτρια ή υψηλή έκφραση της fascin-1 (≥10%) συνδέθηκε με προχωρημένο στάδιο της νόσου (p <0,001), υψηλότερο ανατομικό στάδιο του όγκου Τ (p = 0,007), την παρουσία λεμφαδενικών (p <0,001) και απομακρυσμένων μεταστάσεων (p = 0,002), χαμηλή διαφοροποίηση όγκου (p = 0,002) και την αγγειακή διήθηση (p < 0,001). Αυξημένη έκφραση του L1CAM ≥5%) συνδέθηκε με προχωρημένο στάδιο της νόσου (p <0,001), υψηλότερο ανατομικό στάδιο του όγκου Τ (p = 0,040), την παρουσία λεμφαδενικών (p <0,001) και απομακρυσμένων μεταστάσεων (p = 0,011). Αυξημένη έκφραση της nectin-1 (≥10%) συνδέθηκε με προχωρημένο στάδιο της νόσου και με λεμφαδενικές μεταστάσεις. Μέτρια ή υψηλή έκφραση της fascin-1(HR: 0.256, 95% CI = 0.082-0.800, p = 0,019) και υψηλή έκφραση του L1CAM (HR: 0.187, 95%CI=0.049-0.483, p=0.001) αποτέλεσαν προγνωστικό δείκτη πενταετούς φτωχής ολικής επιβίωσης ανεξάρτητα από άλλα κλινικοπαθολογικά χαρακτηριστικά. H nectin-1 αποτέλεσε ανεξάρτητο προγνωστική δείκτη τριετούς επιβίωσης ελεύθερης νόσου (progression free survival) (HR= 0,389, 95% CI = 0,156-0,972, p = 0,043). Συμπεράσματα: Η υψηλή έκφραση της fascin-1, του L1CAM και της nectin-1 στον καρκίνο του παχέος εντέρου συνδέονται με την εμφάνιση επιθετικών φαινοτύπων. Τα καρκινικά κύτταρα που εκφράζουν αυτούς του δείκτες φέρονται να έχουν ιδιότητες βλαστικών κυττάρων γεννώντας το ερώτημα αν οι δείκτες αυτοί θα μπορούσαν να αποτελέσουν στόχους για την ανάπτυξη θεραπείας με μονοκλωνικά αντισώματα. Επιπροσθέτως, ειδικά στον πρώιμο καρκίνο του παχέος εντέρου οι fascin-1 και L1CAM θα μπορούσαν να χρησιμοποιηθούν για τη δημιουργία μίας μοριακής δοκιμασίας τύπου oncotype για την ταυτοποίηση ασθενών πρώιμου σταδίου με υψηλό κίνδύνο για υποτροπή της νόσου.Background: Colorectal cancer is the third most common cancer and the fourth most common cause of death worldwide, accounting for approximately 1 to 2 million new cases and 600,000 deaths per year. It is estimated that in 2019 in USA there will be 51,020 of colorectal cancer associated deaths cancer and 101,420 newly diagnposed patients. Although treatment of colorectal cancer has been substantially improved, however, a significant proportion exists that present disease recurrence and eventually cancer associated death. From a molecular point occurrence of disease recurrence can be partially explained by the presence of a subpopulation of cancer cells within the tumor that present stem cell properties and are able to escape from adjuvant therapy. Thus, research interest has focused on identifying markers expressed in these cells which could represent therapeutic targets. Fascin is the main actin cross-linker in filopodia Filopodia are formed after fascin binds to 10–30 parallel actin filaments together into straight, compact, and rigid bundles which further provide further mechanical stiffness to actin bundles. L1CAM is a stem cell marker, cell adhesion molecule and belongs to the immunoglobulin superfamily of cell adhesion molecules. Nectins are a family of immunoglobulin-like cell adhesion molecules comprised of four members that essentially contribute to the formation of cell-cell adhesions and regulate a series of cellular activities. The aim of this study was to investigate the expression patterns of fascin-1, L1CAM and nectin-1 in colorectal cancer and to assess their clinical significance. Patients and Methods: 111 specimens of patients with primary colorectal cancer were examined by immunohistochemistry for the expression of fascin-1, L1CAM and nectin-1. Results were correlated with clinicopathological and survival data. Results: Fascin-1, L1CAM and nectin-1 demonstrated intense staining in the cytoplasm of colorectal cancer cells. Fascin-1, in addition, presented intense staining in the endothelial cells of the blood vessels of the tumor. Moderate or high expression of fascin-1 (≥10%) was associated with advanced stage of the disease (p <0.001), higher anatomic stage T (p = 0.007), presence of lymph nodes (p <0.001) and distant metastases (p = 0.002), high grade tumors (p = 0.002) and vascular infiltration (p <0.001). Increased L1CAM expression (≥5%) was associated with advanced stage of disease (p <0.001), higher anatomic stage T (p = 0.040), lymph node (p <0.001) and distant metastases (p = 0.011). High expression of nectin-1 (≥10%) was associated with advanced disease stage and lymph node metastases. Moderate or high expression of fascin-1 (HR: 0.256, 95% CI = 0.082-0.800, p = 0.019) and high L1CAM expression (HR: 0.187, 95% CI = 0.049-0.483, p = 0.001) were identified as prognostic factors of 5 year overall survival independent of other clinicopathological features. Nectin-1 was an independent predictor of progression free survival (HR = 0.389, 95% CI = 0.156-0.972, p = 0.043) Conclusions: High expression of fascin-1, L1CAM and nectin-1 in colorectal cancer is associated with the presence of aggressive phenotypes. A stem-cell-like state could potentially explain the aggressive clinical profile in colorectal cancer of cancer cells expressing these markers, raising the question of whether these markers could represent possible therapeutic targets. In addition, especially in early stage colorectal cancer, fascin-1 and L1CAM could be utilized for the development of a tumor profiling test in order to identify patients that are prone to disease recurrence manifested either as local relapse or mestastasis

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Various breast cancer reconstruction methods and novel surgical techniques include autologous or allogenic procedures, which can increase patient’s quality of life and provide options when dealing with patients seen as challenging clinical scenarios. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; Our aim was to review the current literature and present published evidence on innovative standards in whole breast reconstruction. Advances in flap monitoring or newly published data regarding neurotization in breast reconstruction, arm lymphedema management, breast implant-associated anaplastic large cell lymphoma reconstruction treatment, and robotic surgery with regard to radiotherapy define innovative standards in the breast reconstruction setting. The role of meshes/acellular dermal matrix and fat grafting as well as optimal sequencing of postmastectomy radiotherapy in autologous and alloplastic breast reconstruction appear highly debatable also in expert panel meetings rendering further clinical research including RCTs imperative. &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; There is an abundance of novel available techniques, which mandate further standardization, facilitating scientific evaluation in an attempt to help surgeons select tailored procedures for each patient with the goal to promote informed decision-making in breast reconstruction. </jats:p