Behind The Knife: The Surgery Podcast

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 Tot

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 Postpa

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.  https://pubmed.ncbi.nlm.nih.gov/25138620/ 3.     P Amid. Rad

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  https://behindtheknife.org/podcast/coda-trial-results-antibiotics-versus-surgery-for-appendicitis/ o   Dr. Flum and his team discuss the 90-day outcomes for th

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 RTI International’s 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

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 https://pubmed.ncbi.nlm.nih.gov/32740235/ Efficacy of Periopertive Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Phase 2 Randomized Clinical Trial JAMA Oncol. 2021 Mar;7(3):421-427 https

Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon.  This is Part 2 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon.  This is Part 1 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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: https://www.ncbi.nlm.nih.gov/pmc/

The Colorectal Surgery Virtual Education team is back with Mock Oral exams.  This is episode 2 of 2 and includes 2 high-yield cases. Also available in video format at www.behindtheknife.org. For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.  

Learning Objectives: ·       Describe the role of portal vein embolization and how it is currently utilized in the setting of metastatic colon cancer ·       Understand adequate functional volume and delineate different methods of increasing a future liver remnant ·       Identify the leading causes of drug-induced liver failure and recognize how these have changed over time Journal Articles: ·       Dueland, et al. “Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases.” JAMA Surgery. 2021;156(6):550-557. https://doi.org/10.1001/jamasurg.2021.0267 ·       Ghabril, et al. “Eight fold increase in the dietary supplement related liver failure leading to transplant waitlisting over the last quarter century in the US.” Liver Transplantation. 31 July 2021. https://doi.org/10.1002/lt.26246 Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and mo

The Colorectal Surgery Virtual Education team is back with Mock Oral exams.  This is episode 1 of 2 and includes 2 high-yield cases.  Also available in video format at www.behindtheknife.org. For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.  

Description:   A patient being surveilled for untreated hepatitis C presents to your clinic for a newly identified liver mass. Hepatocellular carcinoma (HCC) accounts for ~90% of new liver cancers and infection by hepatitis B and hepatitis C viruses are the main risk factors. Non-alcoholic steatohepatitis associated with metabolic syndrome and diabetes mellitus, however, have contributed to HCC becoming the fastest growing solid organ tumor in the United States. In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on a surgeons approach to this growing patient population. Learning Objectives:  In this episode, we review risk factors for hepatocellular carcinoma, key steps in the diagnostic work-up with a focus on pre-operative planning for hepatectomy in cirrhotic patients. We will cover interventions available preoperatively, options and considerations once in the operating room, as well as treatment strategies and shifting paradigms following successful resection.  Host

Ever wonder why some bariatric patients received extended VTE prophylaxis and others do not? Or what the ideal chemical VTE prophylaxis is for bariatric patients? All of your questions answered in this journal review discussion! Journal articles: A single-center comparison of extended and restricted thromboprophylaxis with LMWH after metabolic surgery: https://pubmed.ncbi.nlm.nih.gov/31641983/ Risk factors for postdischarge venous thromboembolism among bariatric surgery patients and the evolving approach to extended thromboprophylaxis with enoxaparin: https://pubmed.ncbi.nlm.nih.gov/33814315/

You’re faced with a challenging case of a patient with rectal cancer and synchronous liver lesion. Where do you start: chemotherapy, chemoradiotherapy, upfront surgery, liver first, rectum first?  Join Drs. Carole Richard, François Dagbert and Maher Al Khaldi as they discuss the management of a patient with rectal cancer with a synchronous hepatic metastasis.  Learning objectives In this episode, we discuss the workup of a rectal tumour associated with synchronous liver metastases, indications for resection of the hepatic lesion, neoadjuvant and adjuvant treatment modalities, survival benefit of resection and patient follow-up.   Reference list: Moulton C-A, Gu C-S, Law CH, Tandan VR, Hart R, Quan D, et al. Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases: A Randomized Clinical Trial. JAMA. 2014;311(18):1863–9. Bahadoer RR, Dijkstra EA, Etten B van, Marijnen CAM, Putter H, Kranenbarg EM-K, et al. Short-course radiotherapy followed by chemotherapy before

"The eyes do not see what the mind does not know." Trauma surgery is riddled with pitfalls.  Take your guard down for a minute and BAM, you are eating humble pie.  Don't let this happen to you!   Join Drs. Bryan Cotton, Teddy Puzio, Krislynn Mueck, and host Patrick Georgoff for a fun, high-yield review.  In this episode (2 of 2), we cover:  Splenic pseudoaneurysm Compartment syndrome Urogenital injury Diaphragm injury Esophageal injury

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss ovarian mass in pediatric surgery. Journal Article links:  Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, et al. Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 2019;54(9):1921-5. https://pubmed.ncbi.nlm.nih.gov/30867096/ Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg 2018;53(7):1387-91. https://pubmed.ncbi.nlm.nih.gov/29153467/

"The eyes do not see what the mind does not know." Trauma surgery is riddled with pitfalls.  Take your guard down for a minute and BAM, you are eating humble pie.  Don't let this happen to you!   Join Drs. Bryan Cotton, Teddy Puzio, Rushabh Dev, and host Patrick Georgoff for a fun, high-yield review.  In this episode (1 of 2), we cover:  Extraperitoneal rectal injury Blunt cerebrovascular injury Chance fractures Cardiac injuries with a negative FAST exam Missed injuries during trauma ex lap