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Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education.
In this episode they discuss his lecture “How to Resuscitate Your Critically Ill Finances”. 
Dr. Mizell can be reached at [email protected]
Book Recommendation:

The Psychology of Money 
https://www.amazon.com/Psychology-Money-Timeless-lessons-happiness/dp/0857197681

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule. 
            
Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health.

Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established. 

Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research 

Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon. 

Important Papers 

Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., … & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028.

Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., … & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332.

Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.
 
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
The grind of surgical training has been celebrated in the past, but to what end? With mounting evidence that supports a high prevalence of burnout in the surgical community, surgical educators and leaders are often called to develop initiatives to address the detrimental and potentially irreversible effects on trainees’ wellness during surgical training. We invite Dr. David Rogers, who has personally experienced burnout, to share his insight and expertise in improving workplace wellness. Spoiler: it’s not as easy as group yoga sessions and daily donuts.

Hosts:
Dr. David Rogers
Dr. Jeremy Lipman
Dr. Judith French
Dr. Amy Han

Learning Objectives
1.     Listeners will be able to define wellness in the context of surgical training.
2.     Listeners will be able to better characterize and recognize signs of burnout among surgeons and surgical trainees.
3.     Listeners will be able identify strategies for overcoming burnout. 
4.     Listeners will be able to apply conceptual frameworks from workplace wellness outside of medicine that can guide developing effective programs that promote wellness in surgical education community.

References:

Torres-Landa S, Moreno K, Brasel KJ, Rogers DA. Identification of Leadership Behaviors that Impact General Surgery Junior Residents’ Well-being: A Needs Assessment in a Single Academic Center. J Surg Educ. 2022;79(1):86-93. doi:10.1016/j.jsurg.2021.07.017

Coverdill JE, Bittner IV JG, Park MA, Pipkin WL, Mellinger JD. Fatigue as impairment or educational necessity? Insights into surgical culture. Acad Med. 2011;86:S69-72.

Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-282. doi:10.1111/j.1365-2923.2008.03282.x

Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. doi:10.1111/medu.12927

Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312 319. doi:10.1111/j.1365-2923.2009.03295.x

Bakker AB, de Vries JD. Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping. 2021;34: 1-21.

Georgiadis F. Author Dr Amit Sood: Rising Through Resilience; Five Things You Can Do To Become More Resilient. Medium. https://medium.com/authority-magazine/author-dr-amit-sood-rising-through-resilience-five-things-you-can-do-to-become-more-resilient-673b0a1e9f2a. Published 2020. Accessed May 10, 2022.

Gino F. Are You Too Stressed to Be Productive? Or Not Stressed Enough? Harvard Business Review. Published October 5, 2017. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough

Goleman D. Primal Leadership, with a New Preface by the Authors : Unleashing the Power of Emotional … Intelligence.Harvard Bus Review Press; 2016.

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we review the genomics of CRLM, discuss a journal article investigating the frequency and impact of these mutations on survival in patients with stage IV disease, and interview the senior author Dr. Jean-Nicholas Vauthey about this research and his career in HPB.

Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center

Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center

Guest:
Jean-Nicholas Vauthey, MD (@VautheyMD) is a Professor of Surgical Oncology, Chief of HPB, and Dallas/Fort Worth Living Legend Chair for Cancer Research at MD Anderson.  He is the Principal Investigator of the study discussed in the episode in addition to numerous other articles describing the genomics of colorectal liver metastases.

Learning Objectives: In this episode, we review basic mutations found in metastatic colorectal cancer and broadly discuss these in a clinical context.  We review a journal article from Kawaguchi et al. in which authors analyze prognostic relevance of signaling pathways in patients undergoing resection of CRLM, later validated in an external cohort of unresected patients.  We conduct an interview with the senior author of the study regarding relevant methodologic details, next steps in his research, and how to apply this information now and in the future to the care of patients with CRLM.

Links to Papers Referenced in this Episode:
Journal Article:
Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg. 2021 Aug;233(2):272-284.e13. doi: 10.1016/j.jamcollsurg.2021.05.027. Epub 2021 Jun 7. PMID: 34111531; PMCID: PMC8666966.

Recommended Additional Podcasts on CRLM:
The AHPBA Podcast:
1.     Episode 1: Dr. Jean Nicolas Vauthey – Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474)

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Acute limb ischemia is simultaneous one of the most fun but frustrating diseases to treat in vascular surgery. In this episode of Behind the Knife, the vascular surgery team gives a concise overview of the diagnosis/workup and treatment of patients with acute limb ischemia and talks about some of the difficult decision making regarding treatment modality given all the exciting technology available today.

Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.

Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.

Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.

Papers discussed in this Episode:
AHA/ACC/SVS, etc Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease
https://pubmed.ncbi.nlm.nih.gov/27851992/

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

It’s 1AM and the emergency department is calling about *insert terrifying foregut problem you haven’t seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team. 

Referenced articles and videos: 

1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017
2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017
3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014. 
4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists’ Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019. 
5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021.
6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018.
7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.)
https://www.uptodate.com/contents/gastric-volvulus-in-adults

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward.

Hosts: 
Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST). 
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master’s in Education in the Health Professions from Johns Hopkins. 
David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education. 

LITERATURE
  1. Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231.
    https://pubmed.ncbi.nlm.nih.gov/33502144/
  2. Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/
  3. Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22.
    https://pubmed.ncbi.nlm.nih.gov/10670864/
  4. Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/
  5. Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61.
    https://pubmed.ncbi.nlm.nih.gov/21092211/

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss TEF management and the use of a post-operative transanastomotic feeding tubes in pediatric surgery.

Journal Article links: 
Wang, C., Feng, L., Li, Y., & Ji, Y. (2018). What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis. BMC Pediatr, 18(1), 385. doi:10.1186/s12887-018-1359-5
Bence, C. M., Rymeski, B., Gadepalli, S., Sato, T. T., Minneci, P. C., Downard, C., . . . Midwest Pediatric Surgery, C. (2021). Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg, 56(1), 47-54. doi:10.1016/j.jpedsurg.2020.09.049

LaRusso, K., Joharifard, S., Lakabi, R., Nimer, N., Shahi, A., Kasasni, S. M., . . . Emil, S. (2022). Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg, 57(1), 41-44. doi:10.1016/j.jpedsurg.2021.09.014
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  Dr. Sharon Stein and Dr. Erin King-Mullins are the guest speakers. They are discussing female leadership, diversity and inclusion topics, and much more! This is episode 2 of 2.

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*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform ***

Subjective and objective GERD are common amongst bariatric surgery patients. Is weight loss alone enough to improve GERD symptoms? Is the vertical sleeve gastrectomy really associated with worsening GERD? What technical factors of the vertical sleeve gastrectomy lead to improved or worsening GERD? Listen to find out!

Journal articles:

The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity https://pubmed.ncbi.nlm.nih.gov/35048247/

Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux in Patients with Obesity: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34254259/

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform ***

How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy.

Learning Objectives: 
In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation. 

Hosts: 
Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.

Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.

Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform ***

In January 2022, the University of Maryland Medical Center performed the world’s first transplant involving a genetically modified animal heart. Join Behind the Knife as we discuss this significant transplant milestone with the 2 surgeons who led this historic case – Dr. Bartley Griffith and Dr. Muhammad M. Mohiuddin! Dr. Bartley Griffith is the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery at UMSOM. Dr. Muhammad Mohiuddin is a Professor of Surgery at UMSOM and established the Cardiac Xenotransplantation Program with Dr. Griffith, the first in the United States.  Tune in to learn about the history of xenotransplantation and the barriers that have been overcome to make xenotransplantation a reality.

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Inspired by recent transplant surgery headlines, in this episode we briefly review the history and challenges of xenotransplantation. We discuss an article recently published in the American Journal of Transplantation describing the transplant of a porcine kidney into a human decedent model.

Learning Objectives
·       Understand the timeline of xenotransplantation and its historical challenges
·       Review a recent article that describes the transplantation of a genetically-modified porcine kidney into a brain-dead human model
·       Discuss ongoing obstacles to successful xenotransplantation and next steps

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

You are faced with a young patient with an advanced colon cancer. You suspect Lynch syndrome. He asks if he should undergo total colectomy as opposed to segmental colectomy. How do you approach such a patient? 

Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about Lynch syndrome, also known as Hereditary Non-polyposis Colorectal Cancer (HNPCC). 

Learning objectives 
–       To understand the rationale for universal testing for MMR deficiency of newly diagnosed colorectal cancers. 
–       To know when to recommend screening for CRC for patients with LS and to those who have undergone resection  
–       To understand the prevalence of cancers other than CRCs associated with Lynch syndrome, especially endometrial cancer. 

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
The landscape of surgery is shifting, reflecting the diverse composition of graduating medical students and the efforts to recruit the most talented people into the field.  It is one thing to have a diverse group of people within surgery, but it is an entirely different thing to ensure a welcoming, supportive environment for them.  In this Journal Club episode, we review these topics from the perspective of eminent surgeons Drs. Caprice and Jake Greenberg, who share with us their insights on recent articles examining the experience of women surgeons and trainees.  We’re joined by Dr. Cary Schlick, who authored one of these articles, to shed light on a key issue for the field. 

Learning Objectives:
·       Identify some of the challenges for women in surgical training programs
·       Discuss how stereotype threat can impact performance
·       Suggest ways to advocate for equity in surgery

References:
Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US – https://doi.org/10.1001/jamasurg.2021.3195
Effects of Gender Bias and Stereotypes in Surgical Training: A Randomized Clinical Trial – https://doi.org/10.1001/jamasurg.2020.1127
Gender Bias and Stereotypes in Surgical Training: Is It Really Women Residents We Need to Worry About? – https://doi.org/10.1001/jamasurg.2020.1561
The effect of gender on operative autonomy in general surgery residents – https://doi.org/10.1016/j.surg.2019.06.006

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Mattox Vegas TCCACS 2022: Ep. 2 

The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 2 of 2.  

The lineup:  

  1. Hasan Alam, MD (@DrHasanAlam) 
  2. Scott Steele, MD (@ScottRSteeleMD) 
  3. Joseph Dubose, MD (check out his exceptional podcast here: https://www.tiger-country.org/
  4. Mathew Martin, MD (@docmartin22) 
  5. Red Hoffman, MD (@redMDND, check out her amazing podcast here: https://thesurgicalpalliativecarepodcast.buzzsprout.com/
  6. Bellal Joseph, MD (@TopKnife_B) 
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 1 of 2.  

The lineup:  

  1. Dennis Kim, MD (@traumaicurounds, check out his amazing podcast here: https://www.traumaicurounds.ca/
  2. Ali Salim, MD (@alisalimMD) 
  3. Jason Smith, MD (@DrJTrauma) 
  4. Meghan Lewis, MD  
  5. Demetrios Demetriades, MD 
  6. Alexander Eastman, MD (@PMHTrauma_ALE) 
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it’s not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results.

Learning Objectives: Blunt Pelvic Hemorrhage

·       Expanding knowledge of management strategies for blunt pelvic hemorrhage
·       Describe propensity score matching and its use in non-randomized studies
·       Compare outcomes of REBOA and preperitoneal pelvic packing (PPP)
·       Critically appraise study design and methods of studies

References
1.     S. Mikdad, I.A.M. van Erp, M.E. Moheb, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020; 51:1834–1839. doi.org/10.1016/j.injury.2020.06.003
2.     S. Asmar, L. Bible, M. Chehab, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons. 2021; 232(1):17-26. doi.org/10.1016/j.jamcollsurg.2020.08.763
3.     B. Joseph, M. Zeeshan, J.V. Sakran, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508. doi:10.1001/jamasurg.2019.0096

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

EPAs are coming in 2023. This isn’t about your carbon emissions, but it will dramatically impact surgery training programs. Join Drs. Karen Brasel, Jeremy Lipman, Judith French, and Amy Han as they discuss Entrustable Professional Activities (EPAs) and how they will change the way we assess trainees.

Learning Objectives
1.     Listeners will be able to define entrustable professional activities (EPAs) within the context of competency-based education during General Surgery residency training
2.     Listeners will be able to understand the impetus behind adopting EPA assessments for surgical trainees. 
3.     Listeners will be able to interpret and apply EPA assessment data based on the discussion of the example scenarios.

References:
Brasel KJ, Klingensmith ME, Englander R, Grambau M, Buyske J, Sarosi G, Minter R. Entrustable professional activities in general surgery: development and implementation. Journal of surgical education. 2019 Sep 1;76(5):1174-86.

Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. Acad Med. 2021;96(7S):S9-S13.

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Dr. Michael Rosen returns to Behind the Knife – this time to discuss his RCT investigating biologic vs. synthetic mesh for single-stage repair of contaminated ventral hernias. Read the full article here in JAMA Surgery: https://jamanetwork.com/journals/jamasurgery/article-abstract/2788222

Dr. Rosen is the director for the Center of Abdominal Core Health at the Cleveland Clinic and has written the “Atlas of Abdominal Wall Reconstruction”. Want to learn more about his work and the Hernia Quality Collaborative? Catch up on Dr. Rosen’s previous episode on Behind the Knife: 

Episode #21 (August 15, 2015): Hernias, Abdominal Wall Reconstruction, and Quality Collaboratives
https://behindtheknife.org/podcast/21-hernias-abdominal-wall-recon-and-quality-collaboratives-dr-michael-rosen/

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Welcome to the third of a six-part series focused on the integration of palliative care into the practice of surgery.  Malignant bowel obstructions occur in 5-43 percent of patients with a diagnosis of advanced primary or metastatic intra-abdominal malignancy and both acute care surgeons and surgical oncologists are called upon to manage this condition. Using the case of an elderly gentleman with gastric outlet obstruction secondary to gastric cancer, in this episode we discuss how to approach a patient with a malignant bowel obstruction, review the medical and surgical options for management, discuss the importance of primary palliative care, define palliative surgery and conclude with a short rant about the necessity of being cognizant of one’s feelings and of taking the time and creating the space to discuss them. 

Fast Fact #45:  Medical Management of Bowel Obstructions

Chapter 8, Malignant Bowel Obstruction in Surgical Palliative Care: A Resident’s Guide

Palliative surgery and the surgeon’s role in the palliative care team: a review.

Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org). 

Dr. Fabian Johnston (@fabianjohnston) is Associate Professor of Surgery and Oncology and Chief, Division of GI Surgical Oncology at Johns Hopkins University.

Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
 
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Umbilical hernias a common diagnoses that general surgeons must manage. Though these hernias are considered relatively simple problems to resolve, certain populations of patients are prone to higher rates of complications. As abdominal wall surgery has advanced, so to have the options that exist in management of primary umbilical hernias. The session will review common clinical circumstances and high-risk patient presentations. We will generally review the approaches to repair and the thought processing and data driving decision making.  
·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. 
·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
·       Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University. 

Seminal Papers in Umbilical Hernia Management
Guidelines for treatment of umbilical and epigastric hernias (Henriksen et al. Br J Surg. 2020.): https://pubmed.ncbi.nlm.nih.gov/31916607/

Hernia-Neck Ratio: Predicting Factors for Complications of Umbilical Hernias (Fueter et al. WJS. 2016.): https://pubmed.ncbi.nlm.nih.gov/27194561/

Safety and effectiveness of umbilical hernia repair in patients with cirrhosis (Hew et al. Hernia. 2018.):https://pubmed.ncbi.nlm.nih.gov/29589135/

Fix it while you can…Mortality after umbilical hernia repair in cirrhotic patients (Hill et al. Amer Journal of Surgery. 2020.): https://pubmed.ncbi.nlm.nih.gov/32988606/

Postoperative complications with retromuscular mesh placement in emergency incisional hernia repair (Juul et al. Scand J Surg. 2021.): https://pubmed.ncbi.nlm.nih.gov/33092472/

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Warning!  There is magic contained in this podcast.  Real magic.  The kind of magic that allows you to understand how to manage the axilla in breast cancer patients.   Join Drs. Rita Mukhtar and Michael Alvarado from the University of California San Francisco for a top-notch show on an important topic. 

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Join our Emergency General Surgery Team as they discuss EGS in patients > 65. 

Introduction

– > 65 = 40% of EGS admissions 
– In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%.
– High risk due to decreased reserve, poor nutritional status, and chronic medical conditions 
– Frailty correlates with poor post-operative outcomes

Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875. 

– retrospective population-based cross-sectional study using administrative data. 
– looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions.
– Note Table 2 provides outcomes broken down by type of surgery
– Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue

Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295. 

– large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses
– primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible. 
– Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months.
– Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis)
– 57% of patients were alive and in their home 5 years later

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Thoughts of esophageal perforations keeping you up at night? Actual esophageal perforations keeping you up at night?  Drs. Brian Louie, Peter White, and Megan Lenihan discuss both the tried-and-true and the cutting-edge management of this challenging problem.

Learning Objectives

– Understand basic principles of management

– Review differences in management based on different underlying pathology and location

– Learn indications and techniques for advanced endoscopic interventions for perforations

– Discuss nutrition planning 

Referenced Material

– Thornblade LW, Cheng AM, Wood DE et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104(1):227-233. DOI: 10.1016/j.athoracsur.2017.03.069
http://dx.doi.org/10.1016/j.athoracsur.2017.03.069

– Watkins JR and Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin 2018; 28(4):541-554. DOI: 10.1016/j.thorsurg.2018.07.002
https://doi.org/10.1016/j.thorsurg.2018.07.002

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A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?  

Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 2 of 2.  In episode 1 we discussed who should get an ED thoracotomy.  Today, we cover how to do it.   

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?  

Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 1 of 2.  In episode 1 we discuss who should get an ED thoracotomy and in episode 2 we cover how to do it.   

Listen to learn about the guidelines, signs of life, ultrasound, survival, and when NOT to do an ED thoracotomy.   

WakeMed Blunt Pulseless Trauma Resuscitation Guideline: https://www.wakemed.org/assets/documents/general-surgery-guidelines/trauma-guidelines/blunt-pulseless-arrest.pdf 

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In the episode we will cover the following learning objectives:

·       Listeners should be able to describe the evolution and changes in definitions sepsis over the past three decades
·       Listeners should be familiar with the three randomized controlled trials that studies early-goal directed therapy
·       Listeners should be able to describe the major changes in the new 2021 SCCM Sepsis Guidelines
·       Listeners should be able to describe the fundamental principles of sepsis management in the ICU

References:

https://www.nejm.org/doi/full/10.1056/nejmoa1401602

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You are seeing a young female patient in the clinic with rectal prolapse. When do you offer surgery?  Does she get a perineal approach or a transabdominal approach?  Open or minimally invasive?  Mesh or no mesh?  Sigmoid resection or no resection?  Join Drs. Abelson, Marcello and Aulet as they take us through the wide world of rectal prolapse!

Learning Objectives:
1.     Describe the difference between rectal prolapse and hemorrhoidal prolapse
2.     List the different approaches to surgical management of rectal prolapse
3.     Discuss the approach to recurrent rectal prolapse

Be sure to check out the associated video below. 

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode… 
            
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established. 

Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research 

Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon. 

Important Papers 

Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223.

Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613.

Jinih M, O’Connell E, O’Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505.

Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034.

Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642.

Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778.

Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828.

Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420.

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
The Vascular Surgery Oral Board Review Book has 60 of the highest yield scenarios that cover the majority of the VSCORE topics in an easy-to-read question and answer format that highlights the most important clinical concepts, concise procedural descriptions, and common surgical complications that everyone should know about the field of Vascular Surgery. Whether you are looking to excel on the wards or crush the boards, this book was created to help you Dominate the Day.

https://behindtheknife.org/premium/

https://www.amazon.com/dp/0578382296?ref_=pe_3052080_397514860

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With more and more EVAR comes more and more endoleaks. But when do they matter and what can/should we do about them? In this episode, we present a case of a stubborn endoleak and use the course to illustrate a simple path towards the management of endoleaks following endovascular aneurysm repair.

Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.

Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.

Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.

Guidelines around Endoleak Management

Society for Vascular Surgery Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm:
Conservative Management of Type II Endoleaks:
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Description: Metachronous colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with metachronous CRLM and how management may change with varying clinical scenarios. 

Learning Objectives: In this episode, we review the initial workup and pre-operative considerations in a patient presenting with metachronous CRLM.  We discuss key aspects of resectability of CRLM, including physiologic and hepatic fitness, biology of the disease, and technical considerations.  We review the timing and common regimens of systemic treatment for differing clinical scenarios, as well as when adjuncts to treatment may be useful (e.g., portal venous embolization).  Finally, we highlight important aspects of intraoperative and postoperative management.

Hosts:

Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center

Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center 

Links to Papers Referenced in this Episode:

NCCN Guidelines for Colon Cancer

Mutation Status of RAS, TP53, and SMAD4 is Superior to Mutation Status of RAS Alone for Predicting Prognosis after Resection of Colorectal Liver Metastases. Clin Cancer Res. 2019 Oct 1;25(19):5843-5851. doi: 10.1158/1078-0432.CCR-19-0863. Epub 2019 Jun 20. PMID: 31221662; PMCID: PMC6774854.

Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1208-15. doi: 10.1016/S1470-2045(13)70447-9. Epub 2013 Oct 11. PMID: 24120480.

FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015 Oct;16(13):1306-15. doi: 10.1016/S1470-2045(15)00122-9. Epub 2015 Aug 31. PMID: 26338525.

Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI-Bevacizumab Versus FOLFOX-Bevacizumab for Metastatic Colorectal Cancer (STEAM). Oncologist. 2019 Jul;24(7):921-932. doi: 10.1634/theoncologist.2018-0344. Epub 2018 Dec 14. PMID: 30552157; PMCID: PMC6656450.

Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015 Apr;26(4):702-708. doi: 10.1093/annonc/mdu580. Epub 2014 Dec 23. PMID: 25538173.
Recommended Additional Podcasts on CRLM:

The AHPBA Podcast:
1.     Episode 1: Dr. Jean Nicolas Vauthey – Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474)
2.     Episode 12:Dr D’Angelica – Colorectal Liver Metastases and Hepatic Artery Infusion Pumps (https://podcasts.apple.com/us/podcast/episode-12-dr-dangelica-colorectal-liver-metastases/id1501441845?i=1000521718184)
Behind the Knife:
1.     Surgical Oncology-Hepatic Artery Infusion Pump (https://podcasts.apple.com/ye/podcast/surgical-oncology-hepatic-artery-infusion-pump/id980990143?i=1000525833877)

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Few audiences appreciate the importance of a properly functioning sphincter like surgeons. Magnetic sphincter augmentation using the LINX device, however, is one area that is beyond the sphincter-related expertise of most surgeons and surgical trainees. Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo review the literature surrounding the use of the LINX device for gastroesophageal reflux disease and how the device stacks up against the current gold standard in anti-reflux surgery, laparoscopic fundoplication, on this journal review episode of Behind the Knife. 

References
1. Skubleny D, Switzer NJ, Dang J, et al. LINX(®) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc. Aug 2017;31(8):3078-3084. doi:10.1007/s00464-016-5370-3
2. Bonavina L, Horbach T, Schoppmann SF, DeMarchi J. Three-year clinical experience with magnetic sphincter augmentation and laparoscopic fundoplication. Surg Endosc. Jul 2021;35(7):3449-3458. doi:10.1007/s00464-020-07792-1
3. Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep. Aug 13 2020;10(1):13753. doi:10.1038/s41598-020-70742-3
4. Alicuben ET, Bell RCW, Jobe BA, et al. Worldwide Experience with Erosion of the Magnetic Sphincter Augmentation Device. J Gastrointest Surg. Aug 2018;22(8):1442-1447. doi:10.1007/s11605-018-3775-0
5. Perry KA. Alternatives to Fundoplication. Presented at SAGES Meeting 2018/16th World Congress of Endoscopic Surgery. April 2018. 
6. Dominguez RV. LINX in GERD. The evolution of the technique. From none to full dissection of the crura. Presented at SAGES Meeting April 2019. 

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
In this episode, our team discusses the management of penetrating liver trauma both before, during, and after surgery. Listen in for helpful tips such as how to perform an intraoperative air cholangiogram, creating an occlusion catheter from a red rubber and a Penrose, and much more!
Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).

Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.

David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.

LITERATURE
1.     Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. Published online September 18, 2021. https://pubmed.ncbi.nlm.nih.gov/34537859/

2.     Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122.
3.     Kodadek LM, Efron DT, Haut ER. Intrahepatic balloon tamponade for penetrating liver injury: rarely needed but highly effective. World J Surg. 2019;43(2):486-489.
https://pubmed.ncbi.nlm.nih.gov/30280221/

4.     EAST Practice Management Guidelines: Selective Nonoperative Management of Hepatic Injury, Blunt
6.   THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY 3-MINUTE EXPERT CONSULT VIDEO: “BALLOON TAMPONADE FOR PENETRATING LIVER TRAUMA.
https://journals.lww.com/jtrauma/Pages/videogallery.aspx?videoId=13

7.     Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106618/

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

What is one of the most energy-intensive and waste-generating areas of the hospital? The operating room! In the new BTK/Annals of Surgery Journal Club, we talk to Dr. Elizabeth Yates and Dr. Louis Nguyen about their new article – “Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room.” They review the impact ORs have on the environment, the consequences this has for patients, and ways surgeons lead efforts to “green” the operating room. As the topic of environmental sustainability becomes a growing concern with each passing year, the surgical workplace is going to play a big role in moving in the right direction. Join us for a great discussion!  

Dr. Yates earned her medical degree from the University of Michigan Medical School. She is currently a General Surgery resident at Brigham and Women’s Hospital where she is now completing two years of protected research time at the Center for Surgery and Public Health while also pursuing a Masters in Public Health focused on Occupational and Environmental Health. She conducts interdisciplinary research examining the interface between surgery, sustainability, and climate change.

Dr. Nguyen is a vascular surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School. He earned his medical and business degrees from the University of Chicago Pritzker School of Medicine, completed his General Surgery residency at Barnes-Jewish Hospital in St. Louis, and completed a vascular surgery fellowship at the Brigham as well. He also currently serves as Vice Chair of Digital Health Systems in the Department of surgery. He is a recognized leader in health services research and outcomes implementation, where he utilizes econometric analyses to better understand clinical outcomes.

Climate change and equity issues permeate all aspects of our life and work.  If you are (or know) a current general surgery resident, help us understand the equity and environmental impacts of residency interviews!

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
In this episode we will explore two challenging transplant surgery cases. In the first, we discuss Nutcracker syndrome and the unique ethical questions that accompanied a living donor case. In the second, we examine a perplexing post-operative development in a complicated liver transplant patient. 

Learning Objectives
·       Understand the presentation and general treatment strategies for renal nutcracker syndrome
·       Discuss protocol and ethical considerations for living donor renal transplants
·       Review portal hypertension physiology, clinical manifestations, and options for treatment

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Chemotherapy or surgery first? What is the contemporary management for patients with locally advanced, resectable gastric cancer, and what does the data show? In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on perioperative treatment of locally advanced gastric cancer and future advances that will benefit surgical patients. 

Learning Objectives: 
In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy. 

Hosts: 
Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.

Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.

Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.

Papers Referenced in this Episode:
Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial
Al Batran et al

Efficacy and Safety of Pembrolizumab or Pembrolizumab Plus Chemotherapy vs Chemotherapy Alone for Patients With First-line, Advanced Gastric Cancer. The KEYNOTE-062 Phase 3 Randomized Clinical Trial
Shitara et al

First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial
Janjigian et al

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss neuroblastoma management in pediatric surgery.

Journal Article links: 
Croteau N, Nuchtern J, LaQuaglia MP. Management of Neuroblastoma in Pediatric Patients. Surg Oncol Clin N Am 2021;30(2):291-304.
Madonna MB, Newman E. Handbook for Children with Neuroblastoma. Updated Spring 2018. Cancer Committee American Pediatric Surgical Association. 2018. https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF
Newman EA, Abdessalam S, Aldrink JH, Austin M, Heaton TE, Bruny J, et al. Update on neuroblastoma. J Pediatr Surg 2019;54(3):383-9.
Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children’s Oncology Group study. Ann Surg 2012;256(4):573-80.
https://pubmed.ncbi.nlm.nih.gov/22964741/

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You are faced with a young patient with low rectal cancer who is a complete responder to neoadjuvant chemoradiotherapy. He asks if he should undergo surgical resection despite the absence of visible tumour. How do you approach such a question? 

Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Watch and Wait strategy for rectal cancer, also known as the Organ Preservation strategy. 

Learning objectives 

–       To understand the rationale for Watch and Wait Strategy and the proportion of patients who become complete clinical responders. 
–       To explain how patients under the Watch and Wait Strategy protocol should be followed up and when to consider a patient a clinical nonresponder.
–       To understand the inclusion criteria for patients in the Watch and Wait Strategy

References

In order throughout the episode [1–3]:

1. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U, Sousa AHS e, et al. Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy. Transactions Meet Am Surg Assoc. 2004;122(NA;):309–16.
2. Valk MJM van der, Hilling DE, Bastiaannet E, Kranenbarg EM-K, Beets GL, Figueiredo NL, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet. 2018;391(10139):2537–45.

3. Fernandez LM, Julião GPS, Figueiredo NL, Beets GL, Valk MJM van der, Bahadoer RR, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study. Lancet Oncol. 2021;22(1):43–50.

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Marginal ulcers are a common cause of abdominal pain following Roux-en-Y gastric bypass. Ever wonder how bariatric surgeons triage abdominal pain in post-bariatric surgery patients? A simplified approach to the work-up of these patients as well as the long-term management of marginal ulcers is included in this episode from your bariatric surgery team at UNMC!

Journal Articles discussed:
1.     Opened Proton Pump Inhibitor Capsules Reduce Time to Healing Compared with Intact Capsules for Marginal Ulceration following Roux-en-Y Gastric Bypass: https://pubmed.ncbi.nlm.nih.gov/27773764/
2.     Thoracoscopic Truncal Vagotomy versus Surgical Revision of the Gastrojejunal Anastomosis for Recalcitrant Marginal Ulcers: https://pubmed.ncbi.nlm.nih.gov/30132208/

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Preoperative Optimization

Recurrences and complications following abdominal wall reconstruction and hernia repair are common challenges for the general surgery. In this episode, the Hernia and Abdominal Wall Reconstruction team discusses evidence-based approaches to preoperative optimization and prehabilitation.  We review patient modifiable risk factors and multi-disciplinary strategies for risk, complication, and recurrence reduction.
·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. 
·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
·       Dr. Emaad Iqbal is a resident in General Surgery at Columbia University Medical Center. 
·       Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University. 

Seminal Papers in Preoperative Optimization
Preoperative Optimization by Orenstein and Martindale: https://pubmed.ncbi.nlm.nih.gov/30138281/
Impact of smoking cessation on wound healing: https://pubmed.ncbi.nlm.nih.gov/22508785/
Prehabilitation in abdominal wall reconstruction: https://pubmed.ncbi.nlm.nih.gov/30138261/

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Why should a surgeon care about breast cancer chemotherapy trials? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the benefits of neoadjuvant chemotherapy over upfront surgery and the role of adjuvant chemotherapy for select patients who harbor residual disease at the time of surgery.

Learning objectives:
– Understand the benefits conferred by neoadjuvant chemotherapy compared to upfront surgery in certain patients with breast cancer
– Learn about the study design and results of the CREATE-X phase 3 randomized controlled trial comparing adjuvant capecitabine to standard therapy in patients with HER2 negative invasive breast cancer with residual disease following cytotoxic neoadjuvant chemotherapy
– Describe the specific benefit of adjuvant capecitabine for triple negative breast cancer patients and discuss its evolving role with recent FDA approval of neoadjuvant pembrolizumab in this group
– Learn about the study design and results of the KATHERINE phase 3 randomized controlled trial comparing adjuvant T-DM1 to trastuzumab in patients with HER2+ invasive breast cancer with residual disease following cytotoxic and HER2-targeted neoadjuvant chemotherapy

Journal article links:
KATHERINE: https://www.nejm.org/doi/full/10.1056/NEJMoa1814017

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Has anyone else ever felt the anxiety of hearing the EMS radio call in a pregnant trauma patient, knowing you will soon be getting two patients in one? How do we prioritize our assessment, diagnostic work up, and treatment options for our patient when we have a second patient growing in her uterus?  Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they discuss how to navigate the physiologic changes and management considerations for the pregnant trauma patient! 

Learning Objectives: 
– Understand the physiology of the pregnant patient and how it changes how we clinically assess them in the trauma bay
– Emphasize the basics of the primary and secondary assessment in the pregnant patient 
– Identify when radiology adjuncts are appropriate
– Identify laboratory and diagnostic adjuncts that are unique to the pregnant patient’s work up
– Discuss treatment options for mom and fetus depending on clinical status

Quick Hits:
1. Sick mom before sick baby – stick to basics and treat mom like any other trauma patient
2. Misuse of seatbelts are an important risk factor for morbidity and mortality in pregnant patients. The lap belt must lie below the uterus and shoulder strap should lie between the breasts.
3. Injured pregnant women should be screened for intimate partner violence.
4. Despite changes in pregnant patient physiology, they can still present with compensated shock. Always have a high index of suspicion when interpreting vital signs and remember to offload patient to the left in order to decompress the IVC. 
5. For fetal viability: get FHT when mother’s condition allows. Remember- Fetal distress could be the first sign of maternal hypovolemia
6. NEVER withhold indicated imaging just to avoid radiation in a pregnant patient. Try shielding the uterus when possible, but always proceed with diagnostic imaging when necessary.
7. One more time- sick mom = sick baby!

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Welcome to the first Surgical Palliative Care Journal Club, the second of a six-part series focused on the integration of palliative care into the practice of surgery.  Join us as we discuss the first study of how to best integrate palliative medicine principles into the care of trauma ICU patients.  We then tackle the question:  Why are surgeons often unwilling to discontinue life-sustaining treatments in the post-operative period?   We discuss a 2013 study about “surgical buy-in” and review alternatives to making “informal contracts” with patients before surgery.  

References:
Mosenthal AC, Murphy PA, Barker LK, et al. Changing the culture around end-of-life care in the trauma intensive care unit. J Trauma. 2008;64(6):1587-1593. doi:10.1097/TA.0b013e318174f112.

Schwarze ML, Redmann AJ, Alexander GC, Brasel KJ. Surgeons expect patients to buy-in to post-operative life support preoperatively: results of a national survey. Crit Care Med. 2013;41(1):1-8. doi: 10.1097/CCM.0b013e31826a4650.
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org). 

Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh).  She is Associate Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research. 

Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.

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5 years of General Surgery residency? Check. Case numbers? Check. Ready for independent practice? Hmmm.  

Join Drs. John D. Mellinger, Jeremy Lipman, Judith French, and Amy Han as we discuss the past, present and future of operative assessment.

Learning objectives:

In this episode, we discuss the current practices of operative assessment in surgical training and the opportunities for improvement. We delve into evidence-based framework for operative performance assessment outlined in “A Proposed Blueprint for Operative Performance Training, Assessment, and Certification.” We explore the distinction between high versus low frequency operations, standards setting, training of assessors, and the role of technology in improving reliability, generalizability, and frequency of operative assessments.    

References:

Bansal N, Simmons KD, Epstein AJ, Morris JB, Kelz RR. Using Patient Outcomes to Evaluate General Surgery Residency Program Performance. JAMA Surg. 2016;151(2):111–119. doi:10.1001/jamasurg.2015.3637

Bell RH Jr, Biester TW, Tabuenca A, et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249(5):719-724. doi:10.1097/SLA.0b013e3181a38e59

Williams RG, Sanfey H, Chen XP, Dunnington GL. A controlled study to determine measurement conditions necessary for a reliable and valid operative performance assessment: a controlled prospective observational study. Ann Surg. 2012;256(1):177-187. doi:10.1097/SLA.0b013e31825b6de4

Williams RG, George BC, Bohnen JD, et al. A Proposed Blueprint for Operative Performance Training, Assessment, and Certification. Ann Surg. 2021;273(4):701-708. doi:10.1097/SLA.0000000000004467

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Cardiac arrhythmias such as atrial fibrillation are common in any ICU. But, adequately addressing additional perioperative considerations is key in the surgical ICU. In this Critical Care episode of Behind the Knife, Drs. Bankhead, Dumas, & Park will address how to approach a critically ill patient who presents with an arrythmia. Hemodynamically stable vs. unstable patients are discussed, as well as the current ACLS guidelines for management of a patient in cardiac arrest. 

Referenced Articles and Guidelines:

1. Van Gelder I, Groenveld H, Crijns H, et al. Lenient versus Strict Rate Control in Patients with Atrial Fibrillation. NEJM 2010. 

2. Walkey A, Hogarth K, Lip G. Optimizing Atrial Fibrillation Management: From ICU and Beyond. CHEST 2015. 

3. AFFIRM Investigators. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. NEJM 2002. 

4. ACLS Training Center: Tachycardia with a Pulse Algorithm. https://www.acls.net/acls-tachycardia-algorithm

5. ACLS Training Center: Cardiac Arrest Algorithm. https://www.acls.net/acls-secondary-survey

6. ACLS Training Center: Acute Coronary Syndromes Algorithm. https://www.acls.net/acute-coronary-syndromes-algorithm

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November is Lung Cancer Awareness Month, and what better way is there to spend your time than getting to know the recent advances in adjuvant therapy for early-stage lung adenocarcinoma? 

Learning Objectives

–        Review work-up and treatment of lung adenocarcinoma
–        Review evidence behind Osimertinib as an adjuvant therapy in EGFR mutation positive disease
–        Review recent advances in gene expression profiles for targeted application of adjuvant chemotherapy
–        Discuss future directions for research
–        Discuss additional advancements in diagnosis, monitoring, and immunotherapy

Referenced Material

–        Wu Y, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med 2020; 383:1711-1723. DOI: 10.1056/NEJMoa2027071  https://www.nejm.org/doi/full/10.1056/NEJMoa2027071
–        Woodard GA, Wang SX, Kratz JR, et al. Adjuvant Chemotherapy Guided by Molecular Profiling and Improved Outcomes in Early Stage, Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018;19(1):58-64. DOI: 10.1016/j.cllc.2017.05.015
–        Woodard GA, Kratz JR, Haro G, et al. Molecular Risk Stratification is Independent of EGFR Mutation Status in Identifying Early-Stage Non-Squamous Non-Small Cell Lung Cancer Patients at Risk for Recurrence and Likely to Benefit From Adjuvant Chemotherapy. Clin Lung Cancer. 2021;20:S1525-7304(21)00212-6. DOI: 10.1016/j.cllc.2021.08.008
https://www.clinical-lung-cancer.com/article/S1525-7304(21)00212-6/fulltext

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Join Behind the Knife’s very own Dr. Scott Steele, Chairman of the Department of Colorectal Surgery at Cleveland Clinic, for a high-level talk on the treatment of T2N0 rectal cancer. 

There is an associated video that goes along with this episode.  Check it out at behindtheknife.org or YouTube.

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Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross as they tackle Cancer Emergencies.  

Case 1 – Learning Points:

  1. These are complex patients and multidisciplinary care should be provided with input from oncology. 
  2. A step-up approach should be used, starting with medical management prior to considering surgery in appropriate patients.
  3. Highly selected patients may benefit from surgery, namely those with a high performance status, a prognosis of months if the bowel obstruction was resolved, minimal carcinomatosis, and a single transition point. Diversion, bypass, or resection are all options, but a patient’s capacity to heal related to recent systemic therapy needs to be taken into account. 
  4. Consent for surgery should focus on goals of care, quality of life, and achievable outcomes, and highlight the inherent risk in patients with advanced disease and a limited lifespan. 
Case 2 – Learning Points:
  1. Colorectal malignancy is an exceedingly common cause of general surgical emergency and requires a thoughtful, systematic approach
  2. The role of stenting as a bridge to surgery in obstructing distal colon malignancy is somewhat controversial but can help to avoid permanent stomas; however there is some potential risk of perforation and possibly disease recurrence
  3. Treatment decisions should take place in the context of an informed discussion with the patient and consideration of both quantity and quality of life whenever possible
  4. Consistent involvement of a multidisciplinary team, including radiology, enterostomal therapy, and surgical oncology can be extremely useful in guiding complex decisions

References:
  1. Shariff F, Bogach J, Guidolin K, Nadler A. Malignant Bowel Obstruction Management Over Time: Are We Doing Anything New? A Current Narrative Review. Ann Surg Oncol. 2021 Oct 18. doi: 10.1245/s10434-021-10922-1. Epub ahead of print.
  2. Ripamonti C, Gerdes H and Easson A. Management of malignant bowel obstruction. Eur J Cancer 2008 May;44(8):1105-15
  3. Chen, T, Huang, Y. & Wang, G. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Onc 15, 164 (2017). 
  4. Olmsted C, Johnson A, Kaboli P, et al. Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration. JAMA Surg. 2014;149(11):1169–75.
  5. Dunn GP, Martensen R, Weissman D.  Surgical palliative care: a resident’s guide. Essex: American College of Surgeons; 2009.
  6. Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83.
  7. National Comprehensive Cancer Network. https://www.nccn.org/. Accessed October 15, 2021.
  8. Shariat-Madar B, Jayakrishnan TT, Gamblin TC, Turaga KK. Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol. 2014 Nov;110(6):666-9. doi: 10.1002/jso.23707. 
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In this episode from the Endocrine Surgery team at BTK we discuss the clinical applications of genetic testing for thyroid cancer. We walk through three cases of thyroid nodules and discuss why and how genetic testing can guide surgical and medical management. As usual we review key points such as imaging criteria for thyroid nodules, the Bethesda system for thyroid cytopathology, and MEN syndromes. We also go into a more nuanced discussion of how progress in genetic testing has led to more variability in management options. 
            
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established. 

Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research 

Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

Important Papers 

Catherine Y Zhu, Ines Donangelo, Deepashree Gupta, Dalena T Nguyen, Joana E Ochoa, Michael W Yeh, Masha J Livhits, Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing, The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages e1240–e1247, https://doi.org/10.1210/clinem/dgaa887

Xing, Mingzhao & Alzahrani, Ali & Carson, Kathryn & Viola, David & Elisei, Rossella & Bendlova, Bela & Yip, Linwah & Mian, Caterina & Vianello, Federica & Tuttle, R & Robenshtok, Eyal & Fagin, James & Puxeddu, Efisio & Fugazzola, Laura & Czarniecka, Agnieszka & Jarząb, Barbara & O’Neill, Christine & Sywak, Mark & Lam, Alfred & Sykorova, Vlasta. (2013). Association Between BRAF V600E Mutation and Mortality in Patients With Papillary Thyroid Cancer. JAMA : the journal of the American Medical Association. 309. 1493-501. 10.1001/jama.2013.3190.

Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567-610. doi:10.1089/thy.2014.0335

Wang JR, Zafereo ME, Dadu R, Ferrarotto R, Busaidy NL, Lu C, Ahmed S, Gule-Monroe MK, Williams MD, Sturgis EM, Goepfert RP, Gross ND, Lai SY, Gunn GB, Phan J, Rosenthal DI, Fuller CD, Morrison WH, Iyer P, Cabanillas ME. Complete Surgical Resection Following Neoadjuvant Dabrafenib Plus Trametinib in BRAFV600E-Mutated Anaplastic Thyroid Carcinoma. Thyroid. 2019 Aug;29(8):1036-1043. doi: 10.1089/thy.2019.0133. PMID: 31319771; PMCID: PMC6707029.

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Adjuvant?  Neoadjuvant?  Short course?  Long course?  The treatment of rectal cancer treatment has come a long way.  Tune in to learn more about Total Neoadjuvant Therapy (TNT) and the mysterious HOLY PLANE.

Learning Objectives:

1.    Describe the rationale for Total Neoadjuvant Therapy (TNT) for rectal cancer
2.    Review the history of chemo and radiation therapy in treatment of rectal cancer
3.    Describe total mesorectal excision 

References

Bahadoer RR, Dijkstra EA, van Etten B et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. doi: 10.1016/S1470-2045(20)30555-6. Epub 2020 Dec 7
Fokas E, Allgäuer M, Polat B et al. Randomized Phase II Trial of Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: CAO/ARO/AIO-12. J Clin Oncol. 2019 Dec 1;37(34):3212-3222. doi: 10.1200/JCO.19.00308
Colorectal Surgery 2021-2022 Virtual Education Series
Follow us on Twitter @CRSVirtualEd
www.crsvirtualed.org

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The American Board of Surgery has a new family leave policy for surgery trainees: https://www.absurgery.org/default.jsp?policygsleave.  What’s new?  Is it enough?  And what does competency-based training have to do with it?  Join Drs. Patrick Georgoff and Shanaz Hossain as they discuss the details with ABS president Dr. Jo Buyske. 

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Tick tock tick tock, 5 min is up! There is a plus sign on the testing stick. And you are…. Pregnant! Congratulations??? Join Drs. Erika Rangel, Eugene Kim, Yue-yung Hu, and Debbie Li as they discuss the challenges surgeons and trainees face as they navigate through pregnancy and parenthood. 

Learning objectives:
In this episode, we learn about the personal experiences including the good, the bad, and the ugly behind pregnancy and parenthood. We discuss about the stigma faced and experienced by many surgeons and trainees, and most importantly, ways we can support our current and future trainees to navigate this deeply personal and should be celebrated occasion in their life. 

References

Incidence of Infertility and Pregnancy Complications in US Female Surgeons https://doi.org/10.1001/jamasurg.2021.3301
Pregnancy and Motherhood During Surgical Training – https://doi.org/10.1001/jamasurg.2018.0153
Perspectives of US General Surgery Program Directors on Cultural and Fiscal Barriers to Maternity Leave and Postpartum Support During Surgical Training – https://doi.org/10.1001/jamasurg.2021.1807
Factors Associated With Residency and Career Dissatisfaction in Childbearing Surgical Residents – https://doi.org/10.1001/jamasurg.2018.2571

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Post-operative pain is a challenging topic most surgeons would prefer not to have to think about, and post-inguinal hernia repair pain can be a particular pain in the…groin. Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo from the University of Washington provide a framework for approaching these challenging patients to help clarify when and how to best evaluate post-inguinal hernia repair pain and identify the patients who might benefit from surgical intervention.

Referenced Articles and Videos: 
1.     D Chen. Mapping for inguinal chronic pain: An approach that all surgeons can do. Your Session: Abdominal Wall Hernia – Provocative Questions in the Practice of Hernia Repair held during the 2017 SAGES Annual Meeting in Houston, TX https://www.youtube.com/watch?v=Yx5zSS3CA-U
2.     J Lange, R Kaufmann, A Wijsmuller, J Pierie, R Ploeg, P Amid. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 2015. 
3.     P Amid. Radiologic Images of Meshoma A New Phenomenon Causing Chronic Pain After Prosthetic Repair of Abdominal Wall Hernias. JAMA Surgery 2004. https://jamanetwork.com/journals/jamasurgery/fullarticle/397607
4.     McCormack K, Scott NW, Go PM, Ross S, Grant AM; EU Hernia Trialists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 
5.     Campanelli G, Pascual MH, Hoeferlin A, Rosenberg J, Champault G, Kingsnorth A, Miserez M. Randomized, controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial. Ann Surg. 2012
6.     Jeroukhimov I, Wiser I, Karasic E, Nesterenko V, Poluksht N, Lavy R, Halevy A. Reduced postoperative chronic pain after tension-free inguinal hernia repair using absorbable sutures: a single-blind randomized clinical trial. J Am Coll Surg. 2014. 
7.     Novik B, Nordin P, Skullman S, Dalenbäck J, Enochsson L. More Recurrences After Hernia Mesh Fixation With Short-term Absorbable Sutures: A Registry Study of 82 015 Lichtenstein Repairs. Arch Surg. 2011. 
8.     Barazanchi AW, Fagan PV, Smith BB, Hill AG. Routine Neurectomy of Inguinal Nerves During Open Onlay Mesh Hernia Repair: A Meta-analysis of Randomized Trials. Ann Surg. 2016.
9.     Bakker WJ, Aufenacker TJ, Boschman JS, Burgmans JPJ. Lightweight mesh is recommended in open inguinal (Lichtenstein) hernia repair: A systematic review and meta-analysis. Surgery. 2020.
https://pubmed.ncbi.nlm.nih.gov/31672519/

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The CODA trial is back – this time to shed light on long-term outcomes for antibiotics versus surgery for appendicitis! Dr. David Flum, lead investigator of the CODA trial, and Dr. Lillian Kao join us today to discuss the results after at least 1 year of follow-up in their patients. Read the full update here in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMc2116018

Utilizing the CODA trial results, Dr. Flum has created an innovative online tool for physicians to use with patients when discussing treatment options for appendicitis. Check out this new resource and keep it in mind next time you wander down to the ED for another patient with appendicitis: www.appyornot.org

Listen to our previous episodes on the CODA Trial:

Episode #321 (October 5, 2020): CODA Trial Results – Antibiotics versus Surgery for Appendicitis 
o   Dr. Flum and his team discuss the 90-day outcomes for the CODA trial as antibiotic treatment gains favor in the setting of the COVID-19 pandemic. 

Episode #109 (June 7, 2017): CODA Trial with Dr. David Flum 
o   Dr. Flum introduces the CODA Trial and the basis of his “pragmatic trial”.

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It’s a brave new world people!  There has been an extraordinary and historic change in the way society interacts with information.  With the COVID pandemic raging misinformation and conspiracy theories have taken off like wildfire.  But why?  And what can we as providers do about it?  Join Drs. Patrick Georgoff and Brian Southwell for this timely discussion.  

Dr. Southwell is Senior Director of the Science in the Public Sphere Program at the Research Triangle Institute’s International Center for Communication Science. He is also Adjunct Professor at Duke University and Adjunct Associate Professor in Health Behavior at the University of North Carolina at Chapel Hill.  Dr. Southwell has published widely on topics such as public understanding of science and emerging infectious diseases. He co-founded the Duke Program on Medical Misinformation, a clinician training initiative to improve patient-provider conversations about misinformation. He also has organized several summits on trust in science and medical misinformation, such as the Misinformation Solutions Forum. In addition, Dr. Southwell created and hosts The Measure of Everyday Life, a public radio show that translates research for general audiences on WNCU, a station based at North Carolina Central University in Durham, NC.   

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Journal Review in HPB – Surgical Outcomes of the SWOG S1505 Trial

Description: Neoadjuvant chemotherapy remains a controversial topic for resectable pancreatic adenocarcinoma. This randomized trial examines surgical and clinical outcomes from peri-operative regimens, mFOLFIRNOX and gem-Abraxane. The HPB Behind the Knife team dives into the specifics of the trial design and findings, as well as sits down with the Principal Investigator Dr. Syed Ahmad himself to ask about the behind-the-scenes decision-making and the investigations yet to come. 

Links to Papers Reviewed in this Episode

Surgical Outcome Results from SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma
Ann Surg. 2020 Sep;272(3):481-486

Efficacy of Periopertive Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Phase 2 Randomized Clinical Trial
JAMA Oncol. 2021 Mar;7(3):421-427

Guest: 
Syed Ahmad, MD (@SyedAAhmad5) is a Professor of Surgery and Chief of the Division of Surgical Oncology at the University of Cincinnati College of Medicine, and the Director of the UC Cancer Center. He is the surgical chair of SWOG, and a co-Principal Investigator of the SWOG S1505 study in addition to numerous other national trials for pancreatic cancer.

Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center

Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center

Other References from this Episode

FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer
N Engl J Med. 2018 Dec 20;379:2395-2406

APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma
J Clin Oncol. 2019 May 20;37:no. 15 suppl:4000.

Operative Standards in Cancer Surgery: Pancreatoduodenectomy: Superior Mesenteric Artery Dissection
American College of Surgeons. 2020 Jun 18.

The AHPBA Podcast 
The Americas Hepato-Pancreato-Biliary Association
 
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Large diameter 26-32Fr chest tubes are the treatment of choice at many institutions for the treatment of traumatic hemothorax, but does the currently available data support that? Are there better options available? Join our team as we discuss the The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial by Dr. N Kulvatunyou et al to address this question.

Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).

Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.

David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.

Journal Articles
The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/33843831/

Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. https://pubmed.ncbi.nlm.nih.gov/33415448/

Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. https://pubmed.ncbi.nlm.nih.gov/24375295/

14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small?
https://pubmed.ncbi.nlm.nih.gov/23188235/

A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter
https://pubmed.ncbi.nlm.nih.gov/28795207/

A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummers-digital-monitoring

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Peripheral Artery Disease – What the $#^% are we talking about?

Peripheral Artery Disease is all about saving peoples legs and lives, but we often don’t talk about PAD lesions with a common clinical language. In this episode of Behind the Knife, the vascular surgery team introduces the Global Vascular Guidelines anddiscusses the WIfI, TASC, and GLASS classifications systems designed to standardize our conversations about PAD lesions and how these fit into treatment decisions.

Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the

Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.

Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of

Michigan.

Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.

Papers discussed in this Episode:

Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia:

Society for Vascular Surgery App:

https://apps.apple.com/app/id1014644425

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