Circulating tumor DNA, more commonly referred to as ctDNA, has emerged as an attractive and potentially highly sensitive biomarker for patients with colorectal cancer. But what exactly is ctDNA, does it have any prognostic value for patients with colorectal liver metastasis, and how can it be incorporated into the management of said patients? In this episode from the HPB team at Behind the Knife, listen in on the discussion about ctDNA and its role in the perioperative management of colorectal liver metastasis.  

Hosts

Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.

Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. 

Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center

Learning Objectives:

-Develop an understanding of what circulating tumor DNA (ctDNA) is. 

-Develop an understanding of what makes ctDNA unique from other “tumor markers” like CEA.

-Develop an understanding of the prognostic value of ctDNA for colorectal liver metastasis (CRLM). 

-Develop an understanding of the current role of ctDNA in the perioperative treatment of patients with CRLM.

-Develop an understanding of how ctDNA can be incorporated into future treatment algorithms for patients undergoing hepatic resection for CRLM.

Papers Referenced (in the order they were mentioned in the episode):

1)    Newhook TE, Overman MJ, Chun YS, et al. Prospective Study of Perioperative Circulating Tumor DNA Dynamics in Patients Undergoing Hepatectomy for Colorectal Liver Metastases. Ann Surg. 2023;277(5):813-820.

https://pubmed.ncbi.nlm.nih.gov/35797554/

2)    Nishioka Y, Chun YS, Overman MJ, et al. Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases. J Am Coll Surg. 2022;234(4):474-483.

https://pubmed.ncbi.nlm.nih.gov/35290266/

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Taking a lactating patient the OR? Prescribing antibiotics? What about a CT scan with IV contrast? Pump and dump, right? WRONG. It's time to get educated! Today, we review the finer points of caring for our lactating patients. 

In this episode Dr. Patrick Georgoff is joined by Dr. Austin Eckhoff, general surgery resident at Duke University, Dr. Annie Dotson, family medicine and breastfeeding medicine physician at Duke University, and Dr. Katrina Mitchell, breast surgeon at Ridley Tree Cancer Center in Santa Barbara, CA. 

Resources: 

https://www.bfmed.org/

https://www.e-lactancia.org/

https://physicianguidetobreastfeeding.org/

- - 

TRASH THE PUMP & DUMP: https://physicianguidetobreastfeeding.org/trash-the-pump-and-dump/trash-pump-dump/

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The American Board of Surgery In-Training Examination will officially be switching from reporting percentile scores by year level to percent of questions correct. What does this change mean for residents? Podcast hosts Dr. Ananya Anand, Dr. Joe L’Huillier, and Dr. Rebecca Moreci are joined by three fellow CoSEF members for this discussion: Dr. Gus Godley, Dr. Colleen McDermott, and Dr. Josh Roshal. 

Hosts:

–Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, [email protected]

–Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101, [email protected]

–Dr. Rebecca Moreci, Louisiana State University, @md_moreci, [email protected]

–COSEF: @surgedfellows

Special guests: 

-Dr. Gus Godley, University of Chicago, [email protected], @GusGodley

-Dr. Colleen McDermott, University of Utah, [email protected]

-Dr. Josh Roshal, Brigham and Women’s Hospital, [email protected], @Joshua_Roshal

Learning Objectives: 

Listeners will:

 – Understand the changes to the ABSITE score reporting by the American Board of Surgery 

– Describe both positive impacts and limitations of this change from the resident perspective

– List possible ideas for further refinements to standardized exams in medicine  

References:

 -Yeo HL, Dolan PT, Mao J, Sosa JA. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surg. Jan 1 2020;155(1):22-30. doi:10.1001/jamasurg.2019.4081 https://pubmed.ncbi.nlm.nih.gov/31617872/

-Sathe TS, Wang JJ, Yap A, Zhao NW, O’Sullivan P, Alseidi A. Proposed Reforms to the American Board of Surgery In-Training Examination (ABSITE). https://www.ideasurg.pub/proposed-absite-reforms/

-Miller AT, Swain GW, Midmar M, Divino CM. How Important Are American Board of Surgery In-Training Examination Scores When Applying for Fellowships? J Surg Educ. 2010;67(3):149-151. doi:10.1016/j.jsurg.2010.02.007 

https://pubmed.ncbi.nlm.nih.gov/20630424/

-Savoie KB, Kulaylat AN, Huntington JT, Kelley-Quon L, Gonzalez DO, Richards H, Besner G, Nwomeh BC, Fisher JG. The pediatric surgery match by the numbers: Defining the successful application. J Pediatr Surg. 2020;55(6):1053-1057. doi:10.1016/j.jpedsurg.2020.02.052 https://pubmed.ncbi.nlm.nih.gov/32197826/

-Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Annals of Vascular Surgery. 2023;94:195-204. doi:10.1016/j.avsg.2023.04.018 

https://pubmed.ncbi.nlm.nih.gov/37120072/

-Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross‐sectional study. Health Sci Rep. 2020;3(2):e2161. doi:10.1002/hsr2.161 https://pubmed.ncbi.nlm.nih.gov/32318628/

-Lucey CR, Saguil A. The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue. Academic Medicine. 2020;95(3):351. doi:10.1097/ACM.0000000000002939 https://pubmed.ncbi.nlm.nih.gov/31425184/

-Natanson H, Svrluga S. The SAT is coming back at some colleges. It’s stressing everyone out. Washington Post. https://www.washingtonpost.com/education/2024/03/18/sat-test-policies-confuse-students/. Published March 19, 2024. Accessed April 5, 2024.

-de Virgilio C, Yaghoubian A, Kaji A, Collins JC, Deveney K, Dolich M, Easter D, Hines OJ, Katz S, Liu T, Mahmoud A, Melcher ML, Parks S, Reeves M, Salim A, Scherer L, Takanishi D, Waxman K.. Predicting Performance on the American Board of Surgery Qualifying and Certifying Examinations: A Multi-institutional Study. Archives of Surgery. 2010;145(9):852-856. doi:10.1001/archsurg.2010.177 https://pubmed.ncbi.nlm.nih.gov/20855755/

-Weighted test content from the ABS: 

https://www.absurgery.org/wp-content/uploads/2023/01/GS-ITE.pdf

-USMLE program announces upcoming policy changes | USMLE. Accessed April 9, 2024. https://www.usmle.org/usmle-program-announces-upcoming-policy-changes

 

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The ABSITE score report is changing… what does it mean? CEO of the American Board of Surgery Dr. Jo Buyske discusses ABSITE and MUCH more.  

Hosts: Dr. Scott Steele, Dr. Nina Clark, Dr. Jessica Millar

Guest: Dr. Jo Buyske, President/CEO of the American Board of Surgery

https://www.absurgery.org/wp-content/uploads/2024/02/ABSITE-Percentiles.pdf 

https://sandbox.absurgery.org/default.jsp?publicdata  

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In this episode our team dives into the diagnosis, workup and management of malignant pleural mesothelioma. Listen as we debate the pros and cons of surgical management of this disease with extrapleural pneumonectomy versus pleural decortication and discuss the nuances of choosing the right approach for the right patient.

Learning Objectives

- Describe the workup and staging of a patient with malignant pleural mesothelioma

- List the subtypes of malignant pleural mesothelioma, characteristics of resectable disease, and patient factors which impact surgical candidacy 

- Describe the approach to an extrapleural pneumonectomy and pleural decortication

- Analyze which surgical approach is best for various subsets of patients

- Describe the adjuvant treatment for malignant pleural mesothelioma

Hosts

Kelly Daus MD, Adam Bograd MD, Peter White MD, Brian Louie MD

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Can appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning.

Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93.

https://pubmed.ncbi.nlm.nih.gov/37436871/

-Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following a decision to operate versus the immediate appendectomy group with surgery taking place between 8pm and 4am and within 6 hours of a decision to operate

-A priori non-inferiority margin of 15% for 30-day complications

-Intention-to-treat analysis with risk difference -12% in favor of the delayed group (p < 0.001)

-Superiority as on per protocol analysis

-Underpowered at 91% due to early closure of study due to loss of reliable day time emergency triage operating time

Paper 2: Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, Leppäniemi A, Mentula P. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023 Oct 28;402(10412):1552-1561.

https://pubmed.ncbi.nlm.nih.gov/37717589/

-Non-inferiority randomized controlled trial comparing appendectomy within 8 hours versus 24 hours

-No difference in rate of perforation on intention-to-treat or per protocol analyses

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Before 1952, open heart surgery was considered science fiction. The heart was off limits to surgeons despite more than half a million Americans dying annually from heart disease. Doing nothing was the strategy. However, the status quo would soon change thanks to a few brave and imaginative surgeons who dared to break the most rigid of medical taboos: Do not touch the human heart. We sat down with Dr. Gerald Imber, author of the new book “Cardiac Cowboys: The Heroic Invention of Heart Surgery” to discuss how five men raced to invent an entirely new field of surgery. 

Guests:

Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife

Nick Teman, MD- Associate Professor of Cardiac Surgery and Critical Care- University of Virginia 

Gerald Imber- Assistant Clinical Professor of Plastic surgery at the Weill-Cornell Medical Center, Attending Surgeon at New York-Presbyterian Hospital, and Director of a private clinic in New York City, NY; Author of “Wendell Black, MD”, “Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted”, and “Cardiac Cowboys: The Heroic Invention of Heart Surgery”. 

Want to hear more from Dr. Imber- be sure to check out his podcast series, Cardiac Cowboys, based on Dr. Imber’s book. You can listen to an introduction of the Cardiac Cowboys series here: https://shorturl.at/rKLM8

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Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss Management of Advanced and Malignant Polyps.  Come with us as we navigate through sessile serrated lesions, pathology reports, and rectal polyp nuances. 

- Susan Galandiuk, University of Louisville, Louisville, Kentucky, @DCREdInChief

- Vladimir Bolshinsky, Peninsula Health, Victoria, Australia, @bolshinskyv

- Sandy Kavalukas, University of Louisville, Louisville, Kentucky, @sandykava

- Hillary Simon, University of Louisville, Louisville, Kentucky, @HillaryLSimon

- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12

- Review colorectal cancer screening for the average risk patient.

- Understand what a malignant polyp is defined as and management strategies. 

- Discuss the pathology review and re-review processes. 

- Church J, et al. Keeping the Cecum Clean: A Randomized, Prospective, Placebo-Controlled Trial of Loperamide as Part of Preparation for Colonoscopy. Diseases of the Colon & Rectum 56(1):p 120-125, January 2013.

https://pubmed.ncbi.nlm.nih.gov/23222289/

- Fan C, et al. Management of Serrated Polyps of the Colon. Curr Treat Options Gastroenterol 16(1):182-202, March 2018.

https://pubmed.ncbi.nlm.nih.gov/29445907/

- Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 115(3): 415-434, March 2020.

https://pubmed.ncbi.nlm.nih.gov/32039982/

- Hyman N, Waye JD. Endoscopic four quadrant tattoo for the identification of colonic lesions at surgery. Gastrointest Endosc 37:56–58, 1991.

https://pubmed.ncbi.nlm.nih.gov/1706283/

- Kaltenbach T, et al. Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy 91(3): 486-519, March 2020.

https://pubmed.ncbi.nlm.nih.gov/32067745/

- Keswani R, et al. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology, 161(2): 701 – 711, Aug 2021.

https://pubmed.ncbi.nlm.nih.gov/34334168/

- Shaukat A, et al. Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 159(5): 1916 - 1934.e2, Nov 2020.

https://pubmed.ncbi.nlm.nih.gov/33159840/

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Join for the third episodes in the Association of Out Surgeons & Allies (AOSA) series for a discussion on LGBTQIA+ healthcare providers and their patients.  

Nina Clark, MD 

- Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center

- Dr. James Taylor, Assistant Professor of Colorectal Surgery at Montefiore Medical Center

- Dr. Alex Bonte, General Surgery PGY4 at Hackensack University Medical Center in Hackensack NJ. 

- Dr. Paige Tannhauser, General Surgery PGY3 (completed) at Allegheny General Hospital in Pittsburgh PA, and currently finishing up a post-doctoral research fellowship at the University of Virginia.

Learn more and get involved with AOSA: https://www.outsurgeons.org

Twitter/X: @OutSurgeons

"Gender Unicorn" schema for terminology: https://transstudent.org/gender/

LGBTQ Healthcare Directory: https://lgbtqhealthcaredirectory.org/

CDC Recommendations in LGBTQ Health: https://www.cdc.gov/lgbthealth/index.htm

WPATH Resources: https://www.wpath.org/ 

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Listen to another episode by the Hernia Team from Carolinas Medical Center as they discuss their approach to open preperitoneal ventral hernia repair. Although uncommonly performed, a preperitoneal approach offers several advantages including the ability to achieve large mesh overlap without the need for myofascial release. The team discusses their tips and tricks for utilizing the preperitoneal space in even the most challenging hernia cases. 

Hosts:

- Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center, @SAyusoMD (Twitter)

- Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center, @THeniford (Twitter)

- Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center, @VedraAugenstein (Twitter)

- Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL) 

Learning Objectives:

- Review standard methods of herniorraphy in open abdominal wall reconstruction

- Introduce the concept of open preperitoneal ventral hernia repair

- Discuss the advantages as well as the standard tips and tricks for performing an open preperitoneal repair

- Review outcomes for preperitoneal hernia repair over time

Podcast Video Clip:  https://www.youtube.com/watch?v=3pMvB0rnokQ

References:

- Novitsky et al, Open Preperitoneal Retrofascial Mesh Repair for Multiply Recurrent Ventral Incisional Hernias, JACS, 2006

https://pubmed.ncbi.nlm.nih.gov/36280505/ 

- Heniford et al, Preperitoneal Ventral Hernia Repair: A Decade Long Prospective Observational Study with Analysis of 1023 Patient Outcomes, Annals of Surgery, 2020

https://pubmed.ncbi.nlm.nih.gov/30080725/ 

- Katzen et al, Open Preperitoneal Ventral Hernia Repair: Prospective Observational Outcomes of Quality Improvement Outcomes Over 18 Years and 1,842 Patients, Surgery, 2023 

https://pubmed.ncbi.nlm.nih.gov/36280505/

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