Abstract Aims Healthcare is one of the largest waste-generating activities contributing to climate change, with surgery the most energy-intense sector. This international survey aimed to evaluate current understanding and perspectives of colorectal surgeons on sustainability, with a specific focus on surgical practice. Methods The European Society of Coloproctology (ESCP) designed an online survey - ECOS-Surgery (ESCP Collecting Opinions on Sustainable Surgery). Questions were divided into three sections to capture demographic characteristics of participants, their awareness on global sustainability with its application to surgical practice, and their perspectives on future directions in sustainability. Results 370 participants from 57 countries answered the survey (median age 39; 75% men; 73% consultant surgeons). Around 60% of them were unaware that the health sector contributed to global greenhouse gas emissions. Delivering sustainable surgery was perceived as a matter of great importance for m
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