Berger-Richardson D, Xu R S, Gladdy R A, McCart J A, Govindarajan A, Swallow C J
Division of General Surgery, Department of Surgery, University of Toronto.
Institute of Medical Science, University of Toronto.
Curr Oncol. 2018 Jun;25(3):e200-e208. doi: 10.3747/co.25.3924. Epub 2018 Jun 28.
Some surgeons change gloves and instruments after the extirpative phase of cancer surgery with the intent of reducing the risk of local and wound recurrence. Although this practice is conceptually appealing, the evidence that gloves or instruments act as vectors of cancer-cell seeding in the clinical setting is weak. To determine the potential effect of further investigation of this question, we surveyed the practices and beliefs of a broad spectrum of surgeons who operate on cancer patients.
Using a modified Dillman approach, a survey was mailed to all 945 general surgeons listed in the College of Physicians and Surgeons of Ontario public registry. The survey consisted of multiple-choice and free-text response questions. Responses were tabulated and grouped into themes, including specific intraoperative events and surgeon training. Predictive variables were analyzed by chi-square test.
Of 459 surveys returned (adjusted response rate: 46%), 351 met the inclusion criteria for retention. Of those respondents, 52% reported that they change gloves during cancer resections with the intent of decreasing the risk of tumour seeding, and 40%, that they change instruments for that purpose. The proportion of respondents indicating that they take measures to protect the wound was 73% for laparoscopic cancer resections and 31% for open resections. Training and years in practice predicted some of the foregoing behaviours. The most commonly cited basis for adopting specific strategies to prevent tumour seeding was "gut feeling," followed by clinical training. Most respondents believe that it is possible or probable that surgical gloves or instruments harbour malignant cells, but that a cancer recurrence proceeding from that situation is unlikely.
There is no consensus on how gloves and instruments should be handled in cancer operations. Further investigation is warranted.
一些外科医生在癌症手术的切除阶段后更换手套和器械，目的是降低局部和伤口复发的风险。尽管这种做法在概念上很有吸引力，但在临床环境中，手套或器械作为癌细胞播种载体的证据并不充分。为了确定进一步研究这个问题的潜在影响，我们调查了广泛的癌症手术外科医生的做法和信念。
采用改良的迪尔曼方法，向安大略省医师和外科医生学院公共登记册上列出的所有945名普通外科医生邮寄了一份调查问卷。该调查包括多项选择题和自由文本回答问题。对回答进行了列表整理，并归纳为多个主题，包括特定的术中事件和外科医生培训。通过卡方检验分析预测变量。
在回收的459份调查问卷中（调整后的回复率：46%），351份符合纳入保留标准。在这些受访者中，52%报告说他们在癌症切除术中更换手套，目的是降低肿瘤播种的风险，40%报告说他们为此目的更换器械。对于腹腔镜癌症切除术，73%的受访者表示他们采取措施保护伤口；对于开放切除术，这一比例为31%。培训和从业年限预测了上述一些行为。采用特定策略预防肿瘤播种最常 cited 的依据是“直觉”，其次是临床培训。大多数受访者认为手术手套或器械有可能或很可能携带恶性细胞，但因这种情况导致癌症复发的可能性不大。
在癌症手术中如何处理手套和器械尚无共识。有必要进行进一步的研究。
