Objective: To systematically retrieve, evaluate, and summarize the evidence regarding tumor-free techniques, thereby providing a foundation for standardizing nursing practices in malignant tumor surgery. Methods: According to the evidence-based “6S” model, a comprehensive search of literature pertaining to tumor-free technology was conducted using both Chinese and English databases. The time frame for this search extended from the inception of the database up until December 2025. Results: A total of 21 articles were included in this review. Among these, there was 1 clinical decision, 7 guidelines, 3 expert consensus documents, 6 systematic reviews, 1 randomized controlled trial, and 3 quasi-experiments. The topics covered encompassed preoperative personnel preparation, establishment of isolation areas, incision protection, body cavity exploration, management of carbon dioxide pneumoperitoneum, puncture needle management, tumor resection techniques, irrigation fluid management practices, surgical instrument handling protocols, and tumor specimen management. In total, there were 10 distinct topics with an aggregate of 27 items addressed. Conclusion: The evidence presented in this study serves as a valuable reference for the standardization of tumor-free techniques. It aims to enhance operating room nurses’ awareness of these techniques and mitigate the risk of iatrogenic tumor implantation and metastasis during surgical procedures.
Professional Committee of Operating Room Nursing, Chinese Nursing Association, 2024, Practice Guidelines for Operating Room Nursing (2024 Edition). People’s Medical Publishing House, Beijing.
Cole WH, 1954, The Problems in Operability. Journal of Ulster Medical Journal, 23(2): 102–116.
Ou H, Huang Y, Xiang L, et al., 2018, Circulating Tumor Cell Phenotype Indicates Poor Survival and Recurrence After Surgery for Hepatocellular Carcinoma. Digestive Diseases and Sciences, 63: 2373–2380.
Wei YT, Wu XH, 2018, Investigation on the Implementation of Surgical Isolation Technology for Malignant Tumors in 30 Provinces. Chinese Journal of Nursing, 53(9): 1060–1066.
Hu Y, Hao Y, 2019, Evidence-Based Nursing. People’s Medical Publishing House, Beijing.
Brouwers MC, Kerkvliet K, Spithoff K, et al., 2016, The AGREE Reporting Checklist: A Tool to Improve Reporting of Clinical Practice Guidelines. BMJ, 352: i1152.
Alper BS, Haynes RB, 2016, EBHC Pyramid 5.0 for Accessing Preappraised Evidence and Guidance. Evidence-Based Medicine, 21(4): 123–125.
Gu Y, Zhang H, Zhou Y, et al., 2018, Quality Assessment Tool for Different Types of Studies: Methodological Quality Assessment of Systematic Reviews. Journal of Nurse Training, 33(8): 701–703.
Yu X, Ye Z, Hu X, et al., 2013, A Novel Method for the Rapid Treatment of Tumor Cell Contamination During Hepatectomy for Hepatocellular Carcinoma. Chinese Journal of Hepatobiliary Surgery, 19(5): 3.
Zhang JY, Gu ZJ, Yang ML, et al., 2014, Heparin Saline Combined with Absolute Ethanol Cleaning Surgical Instruments to Eliminate Inactivated Tumor Cells. Journal of Nursing Science, 29(22): 35–38.
The Joanna Briggs Institute, 2013, JBI Levels of Evidence, visited on December 12, 2024, https://jbi.global/sites/ default/files/2019-05/JBI-Levels-of-evidence_ 2014_0.pdf.
Aurora P, William JM, Andrew TB, 2023, Complications of Laparoscopic Surgery, visited on December 12, 2024, http://uptodate.114.255.80.174:8084/contents/complications-of-laparoscopic-surgery.
AORN, 2021, Guideline Quick View: Specimen Management. AORN Journal, 113(1): 115–121.
Speth J, 2021, Guidelines in Practice: Sterile Technique. AORN Journal, 120(4): 238–247.
Zerey M, Hawver LM, Awad Z, et al., 2013, SAGES Evidence-Based Guidelines for the Laparoscopic Resection of Curable Colon and Rectal Cancer. Surgical Endoscopy, 27(1): 1–10.
Kyle E, 2023, Sterile Technique. AORN Journal, 117(1): 64–69.
Roberts ME, Neville E, Berrisford RG, et al., 2010, Management of a Malignant Pleural Effusion: British Thoracic Society Pleural Diseases Guideline 2010. Thorax, 65(Suppl 2): ii32–ii40.
Rey JF, Beilenhoff U, Neumann CS, et al., 2010, European Society of Gastrointestinal Endoscopy (ESGE) Guideline: The Use of Electrosurgical Units. Endoscopy, 42(9): 764–772.
Wang Y, Wang Y, Wang Y, et al., 2023, Chinese Expert Consensus on Laparoscopic Puncture Site Metastasis of Gynecological Malignant Tumors (2023 Edition). Chinese Journal of Practical Gynecology and Obstetrics, 39(6): 626–632.
Wei YT, Chuai WJ, Chen TH, et al., 2020, Expert Consensus on Surgical Isolation Techniques for Lung Malignancies. Chinese Journal of Nursing, 55(9): 1359–1360.
Colorectal Cancer Group, Cancer Society, Chinese Medical Association, 2024, Chinese Expert Consensus on Surgical Margin of Rectal Cancer (2024 Edition). Chinese Journal of Gastrointestinal Surgery, 27(6): 24.
Zhou D, Liu QX, Deng XF, et al., 2015, Comparison of Two Different Mechanical Esophagogastric Anastomosis in Esophageal Cancer Patients: A Meta-Analysis. Journal of Cardiothoracic Surgery, 10: 67.
Pop-Vicas AE, Abad C, Baubie K, et al., 2020, Colorectal Bundles for Surgical Site Infection Prevention: A Systematic Review and Meta-Analysis. Infection Control & Hospital Epidemiology, 41(7): 805–812.
Zhou C, Ren Y, Li J, et al., 2014, Association Between Irrigation Fluids, Washout Volumes and Risk of Local Recurrence of Anterior Resection for Rectal Cancer: A Meta-Analysis of 427 Cases and 492 Controls. PLoS One, 9(5): e95699.
Rondelli F, Trastulli S, Cirocchi R, et al., 2012, Rectal Washout and Local Recurrence in Rectal Resection for Cancer: A Meta-Analysis. Colorectal Disease, 14(11): 1313–1321.
Matsuda A, Kishi T, Musso G, et al., 2013, The Effect of Intraoperative Rectal Washout on Local Recurrence After Rectal Cancer Surgery: A Meta-Analysis. Annals of Surgical Oncology, 20(3): 856–863.
Coccolini F, Catena F, Glehen O, et al., 2016, Effect of Intraperitoneal Chemotherapy and Peritoneal Lavage in Positive Peritoneal Cytology in Gastric Cancer: A Systematic Review and Meta-Analysis. European Journal of Surgical Oncology, 42(9): 1261–1267.
Teoh YC, Cheng CH, Tsang CF, et al., 2024, Transurethral En Bloc Resection Versus Standard Resection of Bladder Tumour: A Randomised, Multicentre, Phase 3 Trial. European Urology, 86(2): 103–111.
Kuhar HN, Shay A, Revenaugh PC, et al., 2021, Cytopathologic Assessment of Gloves and Instruments After Major Head and Neck Surgery. American Journal of Otolaryngology, 42(3): 102876.
Zhang JY, Yang ML, Wu YS, et al., 2007, Pathological Observation of Exfoliated Tumor Cells in Surgical Objects. Chinese Journal of Nursing, 16: 57–58.
Eng MK, Katz MH, Bernstein AJ, et al., 2008, Laparoscopic Port-Site Metastasis in Urologic Surgery. Journal of Endourology, 22(8): 1581–1585.
Zhu L, Lu X, Chen T, et al., 2019, Implementation of Tumor Surgery Isolation Technology and Its Influencing Factors Among Operating Room Nurses in Class III Grade A Hospitals. Nursing Research, 33(14): 2500–2502.
Uppal S, Gehrig PA, Peng K, et al., 2020, Recurrence Rates in Patients with Cervical Cancer Treated with Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study. Journal of Clinical Oncology, 38(10): 1030–1040.
Berger-Richardson D, Xu RS, Gladdy RA, et al., 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.
Gresham E, Don Parsa F, 2020, Iatrogenic Implantation of Cancer Cells During Surgery. Hawai’i Journal of Health & Social Welfare, 79(1): 4–6.