The Surgeon

A News Bulletin published by the Foundation for Abdominal Surgery,
675 Main Street, Melrose, MA 02176
Editor: Demostene Romanucci, MD

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The Surgeon Newsletter

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June 2001

In this issue:

Congratulations to our new officers:

Jess Garcia, M.D., President,
Parnell Avery, M.D., President Elect
James Oglesby, M.D., Vice President.

The 42nd Clinical Congress

The 42nd Clinical Congress held in Atlantic City, New Jersey was an excellent program. On Monday, May 7, 2001 an On-Site Survey and Activity Review was conducted by ACCME surveyors. The principals involved were Drs. Louis F. Alfano, Sr., Demostene Romanucci and George Membrino, Consultant. This involved a total of six hours and the surveyed felt that things went very well and anticipate a four-year full accreditation. We shall know by August 2001.

In reviewing the Evaluation Forms, the two lecturers on nutrition, Mark L. DeLegge, M.D., Associate Professor of Medicine at the Medical University of South Carolina and Robert G. Martindale, M.D., PhD. Associate Professor of Surgery at the Medical College of Georgia, and the presentations by Paul Sugarbaker, M.D. and Mr. Brendan J. Moran, Mch. of Hampshire, UK, received the highest evaluations for their work.

Matthew M. Campbell, M.D. from the Eastern Virginia Medical School was the recipient of the Resident’s Research Award. Donald J. Palmisano, M.D., J.D., American Medical Association Trustee attended the Wednesday morning lectures and presented his message in response to our queries and concerns regarding linkage of hospital staff appointments, participation in HMO’s and ABMS Board status. This was very well received.

The Distinguished Service Award was presented to Paul H. Sugarbaker, M.D., Director of Surgical Oncology, Peritoneal Carinomatosis Program at the Washington Hospital Center and Cancer Institute, for his many contributions and innovations to cancer surgery. The following was his address to the Society members:

"Trends are prominent in surgery and medicine. The pendulum swings towards and then away from treatments, as new information becomes available and new pressures are felt by the practitioner. When I was a Resident at the Peter Bent Brigham Hospital in Boston the benefits of wide resection and careful handling of tissues in a colorectal cancer operation were widely advocated. The works of Warren Cole and his concepts of ‘Iatrogenic cancer dissemination’ were frequently discussed. Rupert Turnbull advocated a ‘No-touch isolation technique’ for colorectal cancer resection. His own personal series was compared to others at the Cleveland Clinic and suggested that he was doing something different than his colleagues. Moss Sterns was convinced that it was the ‘Wide resection with generous lateral margins,’ that made a difference.

"In the 80’s and 90’s the role of the surgeon in curing cancer seems to disappear. The important trials all tested new multimodality treatments. Radiation therapy and chemotherapy were said to be necessary for an optimal gastrointestinal cancer survival. In my opinion, this emphasis on multimodality treatments was developed to the exclusion of excellence in surgical technology.

"In the new millennium clinical data clearly shows that surgical skill is the number one prognostic variable in gastrointestinal cancer. The Stockholm County experience that Mr. Moran presented shows the impact that improved surgical technology can bring to bear on the survival on rectal cancer patients1. Similar findings where there is a markedly improved single institution experience in gastric cancer and pancreas cancer are an accepted part of the peer-reviewed literature.

"Our challenge as abdominal surgeons and members of the American Society of Abdominal Surgeons is to recognize the technical components of gastrointestinal cancer surgery that lead to an optimal survival. We must do this within the context of DRG’s, pressures for rapid patient discharge after surgery and the beliefs of medical oncologists that all cancer surgery is the same. Our challenge is to recreate the Stockholm County experience by implementing within the Society a demonstration project that will bring about perfect clearance and optimal containment of the cancerous process with these intraabdominal malignancies. Surgical responsibilities go beyond the mere removal of the primary cancer. The surgeon must accept as his responsibility the eradication of microscopic residual disease. Acceptance of cancer dissemination, as part of the resection process, is no longer an option.

"The challenge has been laid out before us. The goals are clear-cut. What is the implementation process?"

1Marting, AL, et al. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project Lancet 2000; 365:93-96

During the Thursday morning presentations, Dr. Sugarbaker proposed a workshop for the members of the Society, doing cancer surgery of the colon and rectum. This is in the planning stage for the 43rd Clinical Congress. The following is requested of Fellows: You are to bring with you information relative to the surgical procedures performed for colorectal cancer of the past several years, the Operative Report, Pathology Report, and the follow-up. Hopefully we will have good support for this planned event.

Mr. Brendan J. Moran of Hampshire, UK, offered those Fellows and others who attended the 42nd Clinical Congress the opportunity to come to Hampshire, UK and do "hands-on" model work including laparoscopic procedures. He would like to have at least five people for this activity. Should we receive response from at least that number, we will proceed with program review and consideration for ACCME credits.

Regretfully the dinner dance was canceled due to inadequate subscription. The Editor was informed that two large national/international meetings held in the U.S. suffered the same fate.

The Executive Committee of the American Society of Abdominal Surgeons requested the Director of CME to reduce the program from 30 PRA credit hours to 20, holding the meetings on Friday, Saturday and Sunday morning and reducing the fee to $425 for the 20 hours and a fee of $200 for fully retired Fellows who are not seeking PRA credit hours. That loss of 20 PRA credit hours will not be made up by any other A.S.A.S. meetings.

The Executive Committee also decided to have all future meetings, until further notice, to be held at the Dr. Blaise F. Alfano Memorial Center in Tampa. This would reduce the cost of travel, accommodations and time away from the office. Lunch Round Table discussions will be done away with and committee meetings will be held during the 45 minute noon recess.

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The 26th N. Frederick Hicken M.D. Hepato-Biliary Symposium

The 26th N. Frederick Hicken M.D. Hepato-Biliary Symposium will be held at the Tampa Study Center from November 9 to 11, 2001. Twenty hours of Category 1 credit are being offered. The GI course usually held on a Thursday is canceled and the speakers who had previously been engaged, will be so notified. We are currently working with Professor Rosemurgy to set up the Hepato-Biliary Symposium for Friday, Saturday and Sunday morning.

Category 1

20 hours

Wingate Inn
3751 E. Fowler Avenue, Tampa, FL 33612
(813) 979-2828, FAX (813) 977-1818

Room Rate:
$69/day plus applicable taxes

$200 (Fellows not needing PRA credits)

The Wingate Inn offers a complimentary expanded hospitality breakfast, fitness center, outdoor pool and indoor whirlpool, free 24-hour business center with computer printer, FAX, and copy machine, complimentary high-speed Internet access available in every guest room. It is also the newest hotel in the area. The rate of $69/day is guaranteed through October 24, 2001. Make your reservations early. Also, remind your friends, colleagues and other Fellows to attend the 26th N. Frederick Hicken M.D. Hepato-Biliary Symposium.

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The ASAS is accredited by the Accreditation Council for Continuing Medical Education to provide Continuing Medical Education for Physicians. The ASAS takes responsibility for the content, the quality and scientific integrity of this CME activity.

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