With Patrick Georgoff (georgoff@gmail.com)
 and Craig Brown (brcraig@med.umich.edu)

Oral Board Review # 9 Spleen and Biliary

Behind the Knife is the world’s #1 surgery podcast.  From high-yield educational topics to interviews with leaders in the field, Behind the Knife delivers the information you need to know.  Tune in for timely, relevant, and engaging content designed to help you DOMINATE THE DAY!

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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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Clinical Challenges in Thoracic Surgery: Malignant Pleural Mesothelioma

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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Journal Review in Emergency General Surgery: Appendicitis

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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Cardiac Cowboys: The Heroic Invention of Heart Surgery

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. 



Hosts: 

- 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



Producer: 

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



Learning objectives: 

- 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. 



References: 

- 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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Clinical Challenges in Colorectal Surgery: Management of Advanced and Malignant Polyps

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



Host: 

Nina Clark, MD 



Guests: 

- 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



Resources Mentioned This Episode: 



"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/ 



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



If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/


Oral Board Review # 9 Spleen and Biliary

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