Sustainable Breast Cancer Surgery in Practice
SUSTAINABLE breast cancer surgery was feasible in a pilot study, with high sentinel node detection rates preserved.
A pilot study suggests that sustainable breast cancer surgery can be introduced in the operating room without undermining early clinical performance. Investigators evaluated a series of environmentally focused interventions in 34 women with hormone receptor positive, HER2 negative, T1 to T2, clinically node negative invasive breast cancer undergoing quadrantectomy and sentinel lymph node biopsy.
The prospective study was conducted between September 2024 and May 2025. Seventeen patients underwent a conventional high impact surgical pathway, while 17 were treated using a green protocol guided by the 5R rule: reduce, reuse, recycle, rethink, and research. The sustainable strategy included indocyanine green for sentinel lymph node biopsy, local anesthesia with intravenous sedation, efforts to minimize waste, reusable gowns, drapes, and instruments, and segregation of non-infectious plastic waste.
Breast Cancer Surgery and Sentinel Node Mapping
Sentinel lymph node identification reached 100% in the technetium 99m group and 94.1% in the indocyanine green group. Although the study was not designed to provide a full quantitative environmental analysis, the authors reported that the green protocol was operationally feasible and associated with preliminary indicators of lower environmental burden.
The sustainable pathway also appeared to reduce elements of perioperative resource use. Patients avoided preoperative hospitalization and radiotracer administration, and 58.8% of those managed with the green approach were discharged on the same day. These findings suggest that sustainable breast cancer surgery may support both environmental goals and a streamlined patient journey in selected cases.
Why Sustainable Breast Cancer Surgery Matters
The authors framed their findings against the urgent backdrop of climate change and the substantial carbon footprint of surgical care. In this context, breast cancer surgery may offer a practical setting in which to test sustainable operating room strategies while maintaining standards of oncologic care.
As a pilot study, the analysis remains preliminary and involved a small cohort. However, the results support further investigation into how sustainable breast cancer surgery protocols can reduce greenhouse gas emissions, limit unnecessary waste, and preserve clinical quality. The study also provides early support for indocyanine green as a feasible alternative to technetium-based mapping within broader efforts to improve sustainability in surgical oncology.
Reference
Allievi R et al. Reducing the environmental impact of breast cancer surgery: a pilot study on sustainable practices in the operating room. Minerva Surg. 2026;81(1):13-21.
