Learning trauma surgery through cytoreductive surgery
Seance of wednesday 29 june 2022 (SÉANCE COMMUNE AVEC LE SERVICE DE SANTÉ DES ARMÉES À L'ÉCOLE DU VAL-DE-GRÂCE)
DOI number : 10.26299/53bx-2143/emem.2022.24.01
Abstract
Aims of the study: The current initial and continuing training of French military digestive surgeons in war surgery (CG) is considered too weak and not very adapted, due to a low incidence of visceral traumatology with a predominantly non-operative management, and a daily surgical practice too far removed from the requirements of CG. On the other hand, cytoreduction surgery (CCR) of peritoneal metastases presents similarities with CG, which led us to evaluate its potential contribution to the initial and ongoing training of French military digestive surgeons in CG.
Patients and methods: we compared two digestive surgery departments of a French Army Training Hospital (HIA): a department dedicated to traumatology (Trauma Center HIA Percy) and a department with a CCR activity (HIA Bégin), to the collection of digestive surgery procedures performed by French digestive surgeons deployed in the last overseas theatres of operations (OPEX) during the last 10 years.
Results: Among the 600 polytrauma patients received in the Trauma Center over 2 years, only 17 were operated on the abdomen with 25 procedures performed. Over the same period, 61 patients underwent CCR surgery with an average of 7 abdominal procedures performed per CCR. Apart from packing and nephrectomies (not performed during CRC), significantly more splenectomies (p=0.004), digestive resections (p<0.001), or gynaecological resections (hysterectomy and/or adnexectomies (p=0.004)) were performed during CCR than during abdominal surgery in the Trauma Center. There was no difference in the performance of digestive stomas (p=1), hepatectomies (p=0.3) or pancreatectomies (p=1).
Conclusion: Thus, the CCR, due to its similarities with CG, seems to be a particularly suitable tool for the initial and ongoing training of French military digestive surgeons in CG. It could also be integrated into the training of civilian trauma surgeons who could be called upon to treat war casualties on national territory in the event of a terrorist attack.
Key words: surgery; war; cytoreduction; training; traumatology.
Patients and methods: we compared two digestive surgery departments of a French Army Training Hospital (HIA): a department dedicated to traumatology (Trauma Center HIA Percy) and a department with a CCR activity (HIA Bégin), to the collection of digestive surgery procedures performed by French digestive surgeons deployed in the last overseas theatres of operations (OPEX) during the last 10 years.
Results: Among the 600 polytrauma patients received in the Trauma Center over 2 years, only 17 were operated on the abdomen with 25 procedures performed. Over the same period, 61 patients underwent CCR surgery with an average of 7 abdominal procedures performed per CCR. Apart from packing and nephrectomies (not performed during CRC), significantly more splenectomies (p=0.004), digestive resections (p<0.001), or gynaecological resections (hysterectomy and/or adnexectomies (p=0.004)) were performed during CCR than during abdominal surgery in the Trauma Center. There was no difference in the performance of digestive stomas (p=1), hepatectomies (p=0.3) or pancreatectomies (p=1).
Conclusion: Thus, the CCR, due to its similarities with CG, seems to be a particularly suitable tool for the initial and ongoing training of French military digestive surgeons in CG. It could also be integrated into the training of civilian trauma surgeons who could be called upon to treat war casualties on national territory in the event of a terrorist attack.
Key words: surgery; war; cytoreduction; training; traumatology.