Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeons’ beliefs and practices

  • D. Berger-Richardson University of Toronto; Sinai Health System
  • R.S. Xu Sinai Health System
  • R.A. Gladdy University of Toronto; Sinai Health System
  • J.A. McCart University of Toronto; Sinai Health System
  • A. Govindarajan University of Toronto
  • C.J. Swallow University of Toronto; Sinai Health System
Keywords: Tumour seeding, cancer recurrence, wound protection, surgical gloves, surgical instruments

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

There is no consensus on how gloves and instruments should be handled in cancer operations. Further investigation is warranted.

Author Biographies

D. Berger-Richardson, University of Toronto; Sinai Health System
Department of Surgery, Division of General Surgery; Institute of Medical Science; Lunenfeld–Tanenbaum Research Institute
R.S. Xu, Sinai Health System
Lunenfeld–Tanenbaum Research Institute
R.A. Gladdy, University of Toronto; Sinai Health System
Department of Surgery, Division of General Surgery; Institute of Medical Science; Lunenfeld–Tanenbaum Research Institute
J.A. McCart, University of Toronto; Sinai Health System
Department of Surgery, Division of General Surgery; Institute of Medical Science; Lunenfeld–Tanenbaum Research Institute
A. Govindarajan, University of Toronto
Division of General Surgery, Department of Surgery; Institute for Clinical Evaluative Sciences
C.J. Swallow, University of Toronto; Sinai Health System
Division of General Surgery, Department of Surgery; Institute of Medical Science; Lunenfeld–Tanenbaum Research Institute
Published
2018-06-27
How to Cite
Berger-Richardson, D., Xu, R., Gladdy, R., McCart, J., Govindarajan, A., & Swallow, C. (2018). Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeons’ beliefs and practices. Current Oncology, 25(3), e200-e208. https://doi.org/10.3747/co.25.3924
Section
Surgical Oncology