Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study.

PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) is a minimally invasive approach relying on physical principles for improving intraperitoneal drug delivery, including optimizing the homogeneity of drug distribution through an aerosol. Feasibility and safety of the new approach are now consolidated and data on its effectiveness are continuously increasing. Although any surgical procedure associated with PIPAC had always been discouraged due to the high risk of complications, surgical practice is constantly changing: with growing expertise, more and more surgical teams associate PIPAC with surgery. PLUS study is part of the retrospective international cohort studies including 10 centers around the world (India, Italy, France, Germany, Belgium, Russia, Saudi Arabia, Switzerland) and 96 cases of combined approaches evaluated through a propensity score analysis. the procedures most frequently associated with PIPAC were not only adhesiolysis, omentectomy, adnexectomy, umbilical/inguinal hernia repairs, but also more demanding procedures such as intestinal resections, gastrectomy, splenectomy, bowel repair/stoma creation. Although the evidence is currently limited, PLUS study demonstrated that PIPAC associated with additional surgical procedures is linked to an increase of surgical time (p < 0.001), length of stay (p < 0.001) and medical complication rate (p < 0.001); the most frequently reported medical complications were mild or moderate in severity, such as abdominal pain, nausea, ileus and hyperthermia. No difference in terms of surgical complications was registered; neither reoperation or postoperative deaths were reported. these results suggest that PIPAC can be safely combined in expert centers with additional surgeries. Widespread change of practice should be discouraged before the results of ongoing prospective studies are available

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

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

Sustainable Highly Selective Toluene Oxidation to Benzaldehyde

Thanks to the well-recognized role of benzaldehyde in industry, nowadays the research of new and sustainable approaches to selectively synthesize such an interesting product is receiving great attention from the chemists’ community. In this paper, a V-based catalytic biphasic system is adopted to perform toluene oxidation to benzaldehyde. Importantly, to pursue sustainability, organic solvents have been avoided, so toluene is used as substrate and co-solvent, together with water. Also, the use of hydrophobic ionic liquids has been explored. To perform oxidation, NH4VO3 catalyst, H2O2, and a safe and inexpensive co-catalyst are used. Among the tested co-catalysts, KF and O2 were found to be the best choice, to guarantee good yields, in mild reaction conditions. In fact, with such a sustainable method, up to 30% of benzaldehyde can be obtained at 60 °C and, more interestingly, the oxidative system can be recharged, raising-up the yield. The entire process results highly selective, since no traces of benzyl alcohol or benzoic acid are detected. Hence, it constitutes a very appealing synthetic route, even suitable to be easily scaled-up at an industrial level

Sustainable highly selective toluene oxidation to benzaldehyde

Thanks to the well-recognized role of benzaldehyde in industry, nowadays the research of new and sustainable approaches to selectively synthesize such an interesting product is receiving great attention from the chemists’ community. In this paper, a V-based catalytic biphasic system is adopted to perform toluene oxidation to benzaldehyde. Importantly, to pursue sustainability, organic solvents have been avoided, so toluene is used as substrate and co-solvent, together with water. Also, the use of hydrophobic ionic liquids has been explored. To perform oxidation, NH4VO3 catalyst, H2O2, and a safe and inexpensive co-catalyst are used. Among the tested co-catalysts, KF and O2 were found to be the best choice, to guarantee good yields, in mild reaction conditions. In fact, with such a sustainable method, up to 30% of benzaldehyde can be obtained at 60 °C and, more interestingly, the oxidative system can be recharged, raising-up the yield. The entire process results highly selective, since no traces of benzyl alcohol or benzoic acid are detected. Hence, it constitutes a very appealing synthetic route, even suitable to be easily scaled-up at an industrial level

Sustainable Highly Selective Toluene Oxidation to Benzaldehyde

Thanks to the well-recognized role of benzaldehyde in industry, nowadays the research of new and sustainable approaches to selectively synthesize such an interesting product is receiving great attention from the chemists’ community. In this paper, a V-based catalytic biphasic system is adopted to perform toluene oxidation to benzaldehyde. Importantly, to pursue sustainability, organic solvents have been avoided, so toluene is used as substrate and co-solvent, together with water. Also, the use of hydrophobic ionic liquids has been explored. To perform oxidation, NH4VO3 catalyst, H2O2, and a safe and inexpensive co-catalyst are used. Among the tested co-catalysts, KF and O2 were found to be the best choice, to guarantee good yields, in mild reaction conditions. In fact, with such a sustainable method, up to 30% of benzaldehyde can be obtained at 60 °C and, more interestingly, the oxidative system can be recharged, raising-up the yield. The entire process results highly selective, since no traces of benzyl alcohol or benzoic acid are detected. Hence, it constitutes a very appealing synthetic route, even suitable to be easily scaled-up at an industrial level.</jats:p

The Road to Technical Proficiency in Cytoreductive Surgery for Peritoneal Carcinomatosis: Risk-Adjusted Cumulative Summation Analysis

Background: Cytoreductive surgery (CRS) is a technically demanding procedure, and there is considerable debate about its safe application. This study investigated the learning curve for CRS and the clinical outcomes of consecutive patients treated by a single surgeon at a single institution. Methods: We collected 251 consecutive patients who underwent CRS for peritoneal metastases by a single surgeon at Fondazione Policlinico Universitario A. Gemelli IRCCS, between January 2016 and December 2020. The learning curve was estimated using the cumulative summation analysis (CUSUM) for operative time (OT). Risk-adjusted CUSUM (RA-CUSUM) charts were developed using a composite variable (surgical failure), defined as the occurrence of at least one of the following events: major postoperative complications (Clavien-Dindo grade &gt;= 3), blood loss &gt;= 500 mL, incomplete cytoreduction. Three learning phases were thus derived from the RA-CUSUM analysis, and were compared in terms of perioperative outcomes. Results: CUSUM-OT showed that the operation time improved significantly after the 161(th) case. RA-CUSUM analysis allowed to break the CRS learning curve into three different phases: phase 1, "the learning phase " (cases 1-99), phase 2 "the experienced phase " (cases 100-188), and phase 3, "the mastership phase " (cases 189-251). The rate of major postoperative complications decreased significantly over the three phases (p = 0.019). Operative time decreased significantly as well (p = 0.031) and was significantly shorter in phase 3 with respect to the other two phases (phase 3 vs phase 2: 420 min vs 500 min, p = 0.017; phase 3 vs phase 1: 420 min vs 503 min, p = 0.021). Blood loss consistently decreased throughout the three phases (p = 0.001). The rate of incomplete cytoreduction was significantly lower in phase 3 than in phase 2 (4.8% vs 14.6%, p = 0.043). Conclusion: The CRS failure rate stabilized after the first 99 cases, and the complete surgical proficiency was achieved after 189 cases. A standardised and mentored learning model is a safer strategy to shorten the learning process, to reduce morbidity and mortality, to improve oncologic outcomes

Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A case report of a multimodal treatment for peritoneal metastases of pancreatic origin

Introduction: Pancreatic ductal adenocarcinoma (PDAC) with peritoneal metastases (PM) has a dismal prognosis and palliative systemic chemotherapy, which represents the standard treatment option, has significant pharmacokinetics limitations and low efficacy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new method of drug delivery that is expected to maximize exposure of peritoneal nodules to antiblastic agents. A combination of systemic chemotherapy and PIPAC may be valuable. Presentation of case: A 55 years old male affected by PDAC with synchronous PM underwent a multimodal treatment comprising systemic chemotherapy and PIPAC without any procedural-related adverse events. Tumor genomic profiling evaluation from peritoneal biopsies addressed further tailored systemic chemotherapy. Discussion: The presented case illustrates the possibility of adding PIPAC to systemic chemotherapy with a fair tolerance profile and good quality of life while allowing monitoring of therapy-response and tailoring of the antiblastic treatment