Behind The Knife: The Surgery Podcast

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

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

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

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 https://www.clinical-lung-cancer.com/article/S1525-7304(17)30150-X/fulltext -        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 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

Drs. Nadler, Nantais, and Skelhorne-Gross tackle Cancer Emergencies, emphasizing multidisciplinary care, surgical options, and informed consent. They discuss the challenges and controversies in managing colorectal malignancy emergencies, emphasizing the importance of quality of life in treatment decisions. The podcast explores the complexities of offering surgery to patients with gynecological cancers and carcinomatosis, highlighting the need for thorough evaluation and consideration of potential complications.

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

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 https://doi.org/10.1016/S1470-2045(20)30555-6 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 https://ascopubs.org/doi/10.1200/JCO.19.00308 Colorectal Surgery 2021-2022 Virtual Education Series Follow us on Twitter @CRSVirtualEd Email us: colorectal.educational.series@gmail.com www.crsvirtualed.org Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

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