Assessment of Oncological Safety, Quality of Life, and Environmental Impact of the Green Breast Surgery Protocol

Breast Cancer (BC) is the leading oncological diagnosis in women with an annual incidence of more than 2 million patients diagnosed every year. Because of growing and ageing of population, by 2040 the BC burden is expected to spread over 3 million new cases and 1 million death every year.

Previous studies have shown that utilizing a conservative approach in breast surgery, followed by radiotherapy, leads to higher overall survival compared to radical mastectomy. In such research, survival with conservative surgery appears to be independent of prognostic factors, tumor characteristics, age, and type of therapy. These findings have paved the way for improvements in patient anaesthesiologic experience, transitioning from general anaesthesia to awake surgery, aiming to reduce the impact of post-operative stress on patient recovery.

Conservative surgery allows for a different anaesthesiologic approach, shifting from general anaesthesia to Monitored Anaesthesia Care (MAC). This form of local anaesthesia, accompanied by sedatives and analgesics dosed to allow spontaneous breathing and airway reflexes, promotes quicker post-operative recovery and less psychological impact on the patient compared to general anaesthesia. A comparison between the two techniques was evaluated using the Quality of Recovery-15 (QoR-15) highlighted a higher score with the use of MAC. Moreover, MAC reduces immunomodulation risk in the early postoperative setting, thus reducing potential long-term oncological outcomes on patients, and promoting a novel less immunosuppressive regimen in frail patients. Several studies in oncological patients demonstrated, in these subsets of patients, that the neoplasm may determine a subclinical impairment of immune response with abnormal response toward non-self or neoplastic cells. In fact, in the era of precision oncology, synergistic effects between drugs, general health status (overweight patients), and BC are investigated to underline the beneficial role of general health measures in long-term outcomes.

Additionally, the COVID-19 pandemic represented a practice-changing accelerator in many healthcare services. Many services tried to gather different procedures in a single hospital admission, to reduce the bed occupancy. Among several innovation, a wider application of telehealth demonstrated that many consultations and healthcare services can be effectively delivered via digital platforms. This approach has the potential not only to improve access to care but also to reduce the environmental impact associated with healthcare practices. Telehealth in the context of breast cancer not only offers advantages in terms of accessibility and continuity of care, but also promotes more sustainable healthcare practices, reducing the environmental impact of medical activities.

Aside from mobility for hospital access, the healthcare industry and hospital facilities contribute to environmental pollution. It was estimated in 2013 that 12% of acid rain, 10% of greenhouse gases (GHG), 10% of smog, 1% of ozone gas depletion, and the production of atmospheric carcinogenic and non-carcinogenic toxins derive from healthcare activities within hospitals, with significant implications for public health.