The public's perspective on the amount of time surgeons spend operating.

BACKGROUND: As waiting lists for elective surgery grow, there seems to be a disconnect between the public's expectations on the amount of time surgeons spend operating compared with reality. On average, a surgeon in the NHS spends one day a week performing elective surgery. We aimed to investigate the public's perception on the amount of time surgeons spend performing elective surgery and what they would desire. METHODS: Members of the public in the UK were approached randomly either on-line or in-person to complete an anonymised 6-question survey. The questionnaire included demographic details, surgical history, occupational experience in the healthcare sector, the number of days a week they believe and wish for surgeons to be performing elective surgery. RESULTS: 252 members of the public responded to the survey (150 females, 102 males). 38.5% have experience working in the healthcare sector and 58.5% have had surgery in the past. 83.7% believe surgeons spend at least 3 days a week performing elective surgery [3-4 days (43.2%), 5-7 days (40.5%)]. 45.7% of respondents want their surgeon to operate between 5 and 7 days per week. CONCLUSION: The public appears to overestimate the amount of time that surgeons spend performing elective surgery and have unrealistic expectations of how much they want their surgeons to operate.

How much time do surgeons spend operating?

BACKGROUND: Worldwide, there is significant variation in the amount of time surgeons spend performing elective surgery. The degree of variation is unknown. The aim of this study was to assess the variation in amount of time that surgeons spend operating worldwide. METHODS: An anonymised electronic survey was sent via email to members of The Upper Gastrointestinal Surgeons (TUGS) and shared via social media. The questionnaire consisted of demographic details (age, gender, country of practice), scope of practice (full time/less than full time; private/public sector), experience and average number of days the surgeon spends performing elective surgery. RESULTS: A total of 225 predominantly general/upper GI surgeons from 47 countries responded. Worldwide, the median number of days that surgeons spend performing elective surgery is 2 days a week. There was significant variation across countries/continents: UK 1 day; North America 2.5 days; Europe 3 days; Asia 2 days; Africa 2 days; South America 1 day; Oceania 1 day (p < 0.0001). All surgeons worldwide preferred to spend 3 days a week performing elective surgery except UK surgeons who desired 2 days a week. CONCLUSION: There is significant variation in the amount of time that surgeons spend performing elective surgery worldwide. Results of this study could inform public expectations and trainee surgeons on ideal opportunities for training. Reasons for the wide variation could be explored.

Systematic review of quality of life after esophagectomy and total gastrectomy in patients with gastro-esophageal junction cancer.

The optimal management of cancer of the gastro-esophageal junction (GEJ) is an area of contention. GEJ tumors are typically resected via total gastrectomy or esophagectomy. Despite many studies aiming to determine the superiority of either procedure based on surgical or oncological outcomes, the evidence is equivocal. Data focusing specifically on quality of life (QoL), however, is limited. This systematic review was performed to determine if there is any difference in patient's QoL after total gastrectomy or esophagectomy. A systematic search of PubMed, Medline and Cochrane libraries was conducted for literature published between 1986 and 2023. Studies that used the internationally validated questionnaires EORTC QLQ-C30 and EORTC-QLQ-OG25, to compare QoL after esophagectomy to gastrectomy for the management of GEJ cancer were included. Five studies involving 575 patients undergoing either esophagectomy (n = 365) or total gastrectomy (n = 210) for GEJ tumors were included. QoL was predominantly assessed at 6, 12 and 24 months postoperatively. Although individual studies demonstrated significant differences in certain domains, these differences were not consistently demonstrated in more than one study. There is no evidence to suggest any significant differences in QoL after total gastrectomy compared to esophagectomy for management of gastro-esophageal junction cancer.

Oesophagectomy or Total Gastrectomy for the Management of Siewert II Gastroesophageal Junction Cancer: a Systematic Review and Meta-analysis.

BACKGROUND: There is no consensus on the ideal surgical management of patients with Siewert type II gastroesophageal junctional (GEJ) cancers. Due to its anatomical location, total gastrectomy and oesophagectomy are widely used methods of resection. The aim of this study was to determine the optimal surgical treatment of these patients. METHOD: A systematic search of PubMed, Medline and Cochrane libraries was conducted for literature published between 2000 and 2022. Studies directly comparing oesophagectomy to gastrectomy for Siewert type II tumours were included. Outcome measures included rates of anastomotic leak, 30-day mortality, R0 resection and 5-year survival. Statistical analysis was performed using Review Manager 5.4. RESULTS: Eleven studies involving 18,585 patients undergoing either oesophagectomy (n = 8618) or total gastrectomy (n = 9967) for Siewert type II GEJ cancer were included. There were no significant differences between the rates of anastomotic leak (OR 0.91, CI 0.59-1.40, p = 0.66) and R0 resection (OR 1.51, CI 0.93-2.42, p = 0.09). Patients undergoing total gastrectomy had a lower 30-day mortality (OR 0.66, CI 0.45-0.95, p = 0.03) and a greater 5-year overall survival (OR 1.49, CI 1.34-1.67, p < 0.001) compared to patients undergoing oesophagectomy. These differences were not statistically significant after excluding two large studies, which accounted for the majority of the total population in the analysis. CONCLUSION: These results suggest that total gastrectomy results in lower 30-day mortality and improved overall survival in patients with Siewert type II GEJ cancer. However, interpretation of these results may be biased by the effect of two large studies.

A stepwise approach to laparoscopic right hemicolectomy with D2 excision. An illustrated video guide for training colorectal surgeons - a video vignette.

We present a stepwise approach to performing a laparoscopic right hemicolectomy along with D2 excision. The video illustrates a modular approach for set up and resection, performed on a 60-year-old male patient, with a cancer in the ascending colon. The procedure is divided into its key steps, which include patient position, port placement and anatomical exposure, medial to lateral dissection with vessel control, sub-ileal dissection, lateral mobilization, hepatic flexure mobilization and extraction with extracorporeal anastomosis. The key regional anatomy is highlighted alongside diagrams illustrating standard anatomy and common anatomical variants. We believe this video provides a valuable resource for trainee surgeons to expand their understanding regarding steps of the procedure and associated anatomy.

Symptoms of nicotine toxicity in subjects achieving high cotinine levels during nicotine replacement therapy.

INTRODUCTION: Nicotine replacement therapy (NRT) aids smoking reduction and cessation. Although NRT is effective and safe, some smokers may achieve high nicotine levels. The purpose of this study was to determine the incidence and severity of nicotine-related adverse events in subjects with levels of cotinine, a metabolite of nicotine, that increased by >50% compared with baseline smoking in controlled clinical trials of NRT. METHODS: Data from participants in randomized, double-blind, controlled trials of various formulations of NRT (Nicorette®), including patch, gum, oral inhaler, sublingual tablet, nasal spray, mouth spray, and combinations, were extracted from a clinical database. Eligible studies were performed between 1989 and 2010. In addition to baseline, at least 1 subsequent plasma or salivary cotinine concentration was measured, and adverse events were recorded simultaneously. Of 28 eligible studies, 24 were smoking cessation studies and 4 were smoking reduction studies. RESULTS: Cotinine levels that increased by >50% above baseline were recorded during treatment in 746 of 7,120 subjects (10.5%). Nausea was reported in 16 subjects (0.2% of the total, upper 99% confidence limit [CL] 0.4%), vomiting in 2 subjects (0.0%, upper 99% CL 0.1%), palpitations in 5 subjects (0.1%, upper 99% CL 0.2%), dizziness in 11 subjects (0.2%; upper 99% CL 0.3%), and headache in 35 subjects (0.5%, upper 99% CL 0.7%). CONCLUSIONS: Typical symptoms indicating nicotine overdose together with high cotinine levels were rare during treatment with NRT. These findings support the safety of NRT for smoking cessation or reduction.