Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps’ vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

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

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

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