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!
Behind the Knife is more than a podcast. Visit http://www.behindtheknife.org to learn more.
Clinical Challenges in Surgery HPB: Pancreatic Head Cancer
Description: Pancreatic adenocarcinoma is a highly lethal cancer with a dismal long-term prognosis requiring complex multidisciplinary planning in order to optimize outcomes. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with a borderline resectable pancreatic head mass.
Learning Objectives: In this episode, we review risk factors for pancreatic adenocarcinoma, key steps of the diagnostic work-up and pre-operative planning, and definitions of resectable, borderline resectable, and unresectable tumors. The history of chemotherapy for pancreatic cancer is briefly reviewed, highlighting the importance of multi-agent regimens and role of neoadjuvant therapy. Finally, we highlight the critical steps of the Whipple procedure.Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical CenterLinks to Papers Referenced in this Episode
Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival
J Gastrointest Surg. 2014 Jan;18(1):16-24
Preoperative biliary drainage for cancer of the head of the pancreas
N Engl J Med. 2010 Jan 14;362(2):129-37
1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience
J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1.
Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial
JAMA. 2013 Oct 9;310(14):1473-81.
Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial
Lancet. 2017 Mar 11;389(10073):1011-1024
FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer
N Engl J Med. 2018 Dec 20;379:2395-2406
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 1;272(3):481-486.doi: 10.1097/SLA.0000000000004155
ASCO Guidelines Potentially Curable Pancreatic Adenocarcinoma
NCCN Guidelines Pancreatic Adenocarcinoma
Surgical Oncology- Hepatic artery infusion pump
Today we have a very special guest on Behind the Knife- Dr Michael D’Angelica. He discusses surgical oncology with his HPB focus along with colorectal liver metastases. The episode digs in deeper on the origin of hepatic artery infusion pump, its surgical technique and common complications and much more. Enjoy!
Clinical Challenges in Trauma Surgery: Penetrating Cardiac Trauma
Clinical Challenges in Trauma Surgery: Penetrating Cardiac TraumaA patient presents with a stab wound to the THE BOX. What do you do? X-ray? FAST? Heal with steel? In this episode, the BTK trauma team discusses your options and gives you a few pro tips along the way.Join Drs. Haut, Feinman, and Sigmon for a high-yield clinical challenge.Hosts:
Elliott 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-5 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
Inaba K, Chouliaras K, Zakaluzny S, et al. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg. 2015;262(3):512-518; discussion 516-518. https://pubmed.ncbi.nlm.nih.gov/26258320/
Teeter W, Haase D. Updates in traumatic cardiac arrest. Emerg Med Clin North Am. 2020;38(4):891-901.https://pubmed.ncbi.nlm.nih.gov/32981624/
Israr S, Cook AD, Chapple KM, et al. Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death? Injury. 2019;50(9):15071510. https://pubmed.ncbi.nlm.nih.gov/31147/183/
Clinical Challenge in Vascular Surgery: Carotid Artery Stenosis
Clinical Challenge in Surgery – Carotid Artery Stenosis
Carotid endarterectomy is a great option for most patients, but what do you do when the lesion extends high in the neck or the neck has been irradiated? In this episode from the Vascular Surgery team at Behind the Knife, we discuss carotid artery stenosis using a real patient case from the University of Michigan. We touch on diagnosis and imaging as well as medical and surgical management of carotid disease with a special discussion about Transcarotid Artery Revascularization (TCAR), a new technique available for the treatment of carotid lesions.
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.
Seminal Papers in Carotid Artery Stenosis
The MRC European Carotid Surgery Trial (ECST): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)09292-1/fulltext
Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACAS Trial): https://jamanetwork.com/journals/jama/article-abstract/388335
The North American Symptomatic Carotid Endarterectomy Trial (NASCET Trial): https://www.ahajournals.org/doi/epub/10.1161/01.STR.30.9.1751
Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER Trial): https://pubmed.ncbi.nlm.nih.gov/26506270/
ROADSTER 2 Trial: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030550
“If you could go back to your very first day of intern year and tell yourself one thing, what would it be?" In this episode, AlleaBelle Gongola joins Scott Steele, Kevin Kniery, and Patrick Georgoff to discuss this very question. Tune in to hear wise answers from previous BTK episodes and fill up on inspiration as we head into a new academic year.
Vascular Trauma Resident Survival Guide Part 3 - Abdomen, Pelvis, and Extremities
Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife.Host: Kevin KnieryGuests: Alexis Lauria and Alec Kersey