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ACS honors Gary L. Timmerman, MD, FACS, with Appreciation Award for service to the ACS Board of Governors
Gary L. Timmerman, MD, FACS, a general surgeon from Sioux Falls, SD, was honored at the American College of Surgeons (ACS) 2014 Clinical Congress with an Appreciation Award for his years of service to the ACS Board of Governors. Dr. Timmerman concluded his tenure as Chair of the Board of Governors at the annual meeting.
During the Board of Governors Dinner October 29, Dr. Timmerman received a plaque commemorating the many roles he has filled at the College. Since 1997, he has served in more than 20 volunteer positions with the ACS, seven of which were on the Board of Governors.
“Dr. Timmerman played an instrumental role during his tenure as Chair of the Board of Governors during this past year. His sensitivity to individuals and issues, wonderful sense of humor, and tireless devotion to the American College of Surgeons will be remembered for many years to come,” said Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services.
Dr. Timmerman became a Member of the Board of Governors in 2007. In 2009, he became a Member of the Board’s Nominating Committee (2009–2010). He has subsequently served as a Member of the Committee to Study the Fiscal Affairs of the College (2013–2014), Vice-Chair of the Ad Hoc Committee to Restructure Board of Governors Committees (2012–2013), Member of the Executive Committee (2011–2012), Vice-Chair of the Board of Governors (2011–2013), and, lastly, Chair of the Board of Governors (2013–2014).
In addition, he is a Past-President of the ACS South Dakota Chapter (1997–1998) and has been a member and chair of numerous other College committees, including the Committee on Young Surgeons and the Nominating Committee of the Fellows.
Dr. Timmerman is an attending surgeon at Sanford Surgical Associates, Sioux Falls, and associate professor and chair, department of surgery, Sanford School of Medicine, University of South Dakota.
Gary L. Timmerman, MD, FACS, a general surgeon from Sioux Falls, SD, was honored at the American College of Surgeons (ACS) 2014 Clinical Congress with an Appreciation Award for his years of service to the ACS Board of Governors. Dr. Timmerman concluded his tenure as Chair of the Board of Governors at the annual meeting.
During the Board of Governors Dinner October 29, Dr. Timmerman received a plaque commemorating the many roles he has filled at the College. Since 1997, he has served in more than 20 volunteer positions with the ACS, seven of which were on the Board of Governors.
“Dr. Timmerman played an instrumental role during his tenure as Chair of the Board of Governors during this past year. His sensitivity to individuals and issues, wonderful sense of humor, and tireless devotion to the American College of Surgeons will be remembered for many years to come,” said Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services.
Dr. Timmerman became a Member of the Board of Governors in 2007. In 2009, he became a Member of the Board’s Nominating Committee (2009–2010). He has subsequently served as a Member of the Committee to Study the Fiscal Affairs of the College (2013–2014), Vice-Chair of the Ad Hoc Committee to Restructure Board of Governors Committees (2012–2013), Member of the Executive Committee (2011–2012), Vice-Chair of the Board of Governors (2011–2013), and, lastly, Chair of the Board of Governors (2013–2014).
In addition, he is a Past-President of the ACS South Dakota Chapter (1997–1998) and has been a member and chair of numerous other College committees, including the Committee on Young Surgeons and the Nominating Committee of the Fellows.
Dr. Timmerman is an attending surgeon at Sanford Surgical Associates, Sioux Falls, and associate professor and chair, department of surgery, Sanford School of Medicine, University of South Dakota.
Gary L. Timmerman, MD, FACS, a general surgeon from Sioux Falls, SD, was honored at the American College of Surgeons (ACS) 2014 Clinical Congress with an Appreciation Award for his years of service to the ACS Board of Governors. Dr. Timmerman concluded his tenure as Chair of the Board of Governors at the annual meeting.
During the Board of Governors Dinner October 29, Dr. Timmerman received a plaque commemorating the many roles he has filled at the College. Since 1997, he has served in more than 20 volunteer positions with the ACS, seven of which were on the Board of Governors.
“Dr. Timmerman played an instrumental role during his tenure as Chair of the Board of Governors during this past year. His sensitivity to individuals and issues, wonderful sense of humor, and tireless devotion to the American College of Surgeons will be remembered for many years to come,” said Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services.
Dr. Timmerman became a Member of the Board of Governors in 2007. In 2009, he became a Member of the Board’s Nominating Committee (2009–2010). He has subsequently served as a Member of the Committee to Study the Fiscal Affairs of the College (2013–2014), Vice-Chair of the Ad Hoc Committee to Restructure Board of Governors Committees (2012–2013), Member of the Executive Committee (2011–2012), Vice-Chair of the Board of Governors (2011–2013), and, lastly, Chair of the Board of Governors (2013–2014).
In addition, he is a Past-President of the ACS South Dakota Chapter (1997–1998) and has been a member and chair of numerous other College committees, including the Committee on Young Surgeons and the Nominating Committee of the Fellows.
Dr. Timmerman is an attending surgeon at Sanford Surgical Associates, Sioux Falls, and associate professor and chair, department of surgery, Sanford School of Medicine, University of South Dakota.
From the Washington Office
Shortly after passage of the $1.1 trillion “Cromnibus,” the House and Senate concluded their legislative business for the 113th Congress and adjourned. Many issues of importance to surgeons and our patients remain unresolved and are expected to be high on the legislative agenda of the 114th Congress in the first quarter of 2015.
Returning as Members of Congress in January will be two physicians whose campaigns were assisted by the active participation of SurgeonsPAC. They are Dr. Ami Bera, an emergency physician from the 7th District of California (Sacramento area) and Dr. Dan Benishek, a general surgeon and fellow of the American College of Surgeons from the 1st District of Michigan (Upper Peninsula). Both Dr. Bera and Dr. Benishek have served as champions for the cause of the legislative agenda supported by the College.
One of the ways by which SurgeonsPAC participated in the re-election campaign of both Members is known as an independent expenditure (IE). The Code of Federal Regulations defines and independent expenditure as an expenditure for a communication that expressly advocates for “the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party committee or its agents.” [11 CFR 100.16(a)]
In August, the Board of Directors of SurgeonsPAC unanimously voted to direct staff of the Division of Advocacy and Health Policy to develop recommendations for independent expenditures for a bipartisan slate of candidates who had a record of being supportive of the College’s legislative agenda and whose election was enough at risk that an independent expenditure by the College would potentially be of significant benefit for their race. In October, the PAC Board considered those recommendations and voted to support the expenditure of $100,000 each for IEs for Dr. Bera, a Democrat, and Dr. Benishek, a Republican. Both have been champions on issues such as repeal and replacement of the Sustainable Growth Rate (SGR), medical liability reform, and repeal of the 96-hour rule.
For Dr. Bera, the SurgeonsPAC dollars were utilized for a radio and direct mail campaign that was part of a larger effort in which other physician political action committees participated similarly. For Dr. Benishek, a television ad was produced and run through local cable providers.
On election night, Dr. Benishek was declared the winner, receiving 52.1% of the vote compared with his opponent’s 45.3%. As one of four fellows of the American College of Surgeons in Congress, we look forward to continuing to work with “Dr. Dan” and his excellent staff in his upcoming third term.
Dr. Bera’s race was much closer, as he actually trailed his opponent when election night closed with 49.8% of the vote. Subsequently, with the counting and inclusion of the mail-in ballots specifically targeted by the physician community’s IE effort, Dr. Bera overtook his opponent’s slim margin. Two weeks later, on 19 Nov. 2014, the Associated Press called the election for Dr. Bera, whose 1,400-vote lead at that time was felt to be substantial enough to preclude his opponent making up the difference with the remaining 4,300 provisional ballots that had yet to be counted. Dr. Bera’s CA-7 district race proved to be the most expensive in the nation with an estimated $19.6 million in total expenditures. Despite representing only 0.51% of that total, SurgeonsPAC’s contribution, in the collective with that of other physician organizations, no doubt played a significant role in returning a physician to Congress to continue to champion our causes.
In my opinion, these examples of careful candidate selection and subsequent support of Drs. Benishek and Bera exemplify the importance of a strong political action committee. The ultimate goal of SurgeonsPAC is the election to Congress and retention in Congress of those who support our policy positions and legislative agenda. Though SurgeonsPAC is one of nine physician PACs that can be accurately labeled as “million dollar” (per election cycle) PACs, our relative size and, thus, the number of candidates like Drs. Bera and Benishek we could support would be much greater if the Fellow participation rate more closely resembled that of our colleagues in other physician organizations. However, year after year, only 3%-4% of Fellows contribute, as compared with participation rates of 10%-25% in those physician PACs larger than SurgeonsPAC.
Recently, all Fellows received an e-mail from Dr. Andrew Warshaw, founding SurgeonsPAC Board Chairman and current President of the ACS, urging Fellows to make a $25 donation to SurgeonsPAC. Those wishing to learn more about the critical role SurgeonsPAC plays in our advocacy efforts can log on to www.surgeonspac.org.
Until next month...
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Shortly after passage of the $1.1 trillion “Cromnibus,” the House and Senate concluded their legislative business for the 113th Congress and adjourned. Many issues of importance to surgeons and our patients remain unresolved and are expected to be high on the legislative agenda of the 114th Congress in the first quarter of 2015.
Returning as Members of Congress in January will be two physicians whose campaigns were assisted by the active participation of SurgeonsPAC. They are Dr. Ami Bera, an emergency physician from the 7th District of California (Sacramento area) and Dr. Dan Benishek, a general surgeon and fellow of the American College of Surgeons from the 1st District of Michigan (Upper Peninsula). Both Dr. Bera and Dr. Benishek have served as champions for the cause of the legislative agenda supported by the College.
One of the ways by which SurgeonsPAC participated in the re-election campaign of both Members is known as an independent expenditure (IE). The Code of Federal Regulations defines and independent expenditure as an expenditure for a communication that expressly advocates for “the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party committee or its agents.” [11 CFR 100.16(a)]
In August, the Board of Directors of SurgeonsPAC unanimously voted to direct staff of the Division of Advocacy and Health Policy to develop recommendations for independent expenditures for a bipartisan slate of candidates who had a record of being supportive of the College’s legislative agenda and whose election was enough at risk that an independent expenditure by the College would potentially be of significant benefit for their race. In October, the PAC Board considered those recommendations and voted to support the expenditure of $100,000 each for IEs for Dr. Bera, a Democrat, and Dr. Benishek, a Republican. Both have been champions on issues such as repeal and replacement of the Sustainable Growth Rate (SGR), medical liability reform, and repeal of the 96-hour rule.
For Dr. Bera, the SurgeonsPAC dollars were utilized for a radio and direct mail campaign that was part of a larger effort in which other physician political action committees participated similarly. For Dr. Benishek, a television ad was produced and run through local cable providers.
On election night, Dr. Benishek was declared the winner, receiving 52.1% of the vote compared with his opponent’s 45.3%. As one of four fellows of the American College of Surgeons in Congress, we look forward to continuing to work with “Dr. Dan” and his excellent staff in his upcoming third term.
Dr. Bera’s race was much closer, as he actually trailed his opponent when election night closed with 49.8% of the vote. Subsequently, with the counting and inclusion of the mail-in ballots specifically targeted by the physician community’s IE effort, Dr. Bera overtook his opponent’s slim margin. Two weeks later, on 19 Nov. 2014, the Associated Press called the election for Dr. Bera, whose 1,400-vote lead at that time was felt to be substantial enough to preclude his opponent making up the difference with the remaining 4,300 provisional ballots that had yet to be counted. Dr. Bera’s CA-7 district race proved to be the most expensive in the nation with an estimated $19.6 million in total expenditures. Despite representing only 0.51% of that total, SurgeonsPAC’s contribution, in the collective with that of other physician organizations, no doubt played a significant role in returning a physician to Congress to continue to champion our causes.
In my opinion, these examples of careful candidate selection and subsequent support of Drs. Benishek and Bera exemplify the importance of a strong political action committee. The ultimate goal of SurgeonsPAC is the election to Congress and retention in Congress of those who support our policy positions and legislative agenda. Though SurgeonsPAC is one of nine physician PACs that can be accurately labeled as “million dollar” (per election cycle) PACs, our relative size and, thus, the number of candidates like Drs. Bera and Benishek we could support would be much greater if the Fellow participation rate more closely resembled that of our colleagues in other physician organizations. However, year after year, only 3%-4% of Fellows contribute, as compared with participation rates of 10%-25% in those physician PACs larger than SurgeonsPAC.
Recently, all Fellows received an e-mail from Dr. Andrew Warshaw, founding SurgeonsPAC Board Chairman and current President of the ACS, urging Fellows to make a $25 donation to SurgeonsPAC. Those wishing to learn more about the critical role SurgeonsPAC plays in our advocacy efforts can log on to www.surgeonspac.org.
Until next month...
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Shortly after passage of the $1.1 trillion “Cromnibus,” the House and Senate concluded their legislative business for the 113th Congress and adjourned. Many issues of importance to surgeons and our patients remain unresolved and are expected to be high on the legislative agenda of the 114th Congress in the first quarter of 2015.
Returning as Members of Congress in January will be two physicians whose campaigns were assisted by the active participation of SurgeonsPAC. They are Dr. Ami Bera, an emergency physician from the 7th District of California (Sacramento area) and Dr. Dan Benishek, a general surgeon and fellow of the American College of Surgeons from the 1st District of Michigan (Upper Peninsula). Both Dr. Bera and Dr. Benishek have served as champions for the cause of the legislative agenda supported by the College.
One of the ways by which SurgeonsPAC participated in the re-election campaign of both Members is known as an independent expenditure (IE). The Code of Federal Regulations defines and independent expenditure as an expenditure for a communication that expressly advocates for “the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party committee or its agents.” [11 CFR 100.16(a)]
In August, the Board of Directors of SurgeonsPAC unanimously voted to direct staff of the Division of Advocacy and Health Policy to develop recommendations for independent expenditures for a bipartisan slate of candidates who had a record of being supportive of the College’s legislative agenda and whose election was enough at risk that an independent expenditure by the College would potentially be of significant benefit for their race. In October, the PAC Board considered those recommendations and voted to support the expenditure of $100,000 each for IEs for Dr. Bera, a Democrat, and Dr. Benishek, a Republican. Both have been champions on issues such as repeal and replacement of the Sustainable Growth Rate (SGR), medical liability reform, and repeal of the 96-hour rule.
For Dr. Bera, the SurgeonsPAC dollars were utilized for a radio and direct mail campaign that was part of a larger effort in which other physician political action committees participated similarly. For Dr. Benishek, a television ad was produced and run through local cable providers.
On election night, Dr. Benishek was declared the winner, receiving 52.1% of the vote compared with his opponent’s 45.3%. As one of four fellows of the American College of Surgeons in Congress, we look forward to continuing to work with “Dr. Dan” and his excellent staff in his upcoming third term.
Dr. Bera’s race was much closer, as he actually trailed his opponent when election night closed with 49.8% of the vote. Subsequently, with the counting and inclusion of the mail-in ballots specifically targeted by the physician community’s IE effort, Dr. Bera overtook his opponent’s slim margin. Two weeks later, on 19 Nov. 2014, the Associated Press called the election for Dr. Bera, whose 1,400-vote lead at that time was felt to be substantial enough to preclude his opponent making up the difference with the remaining 4,300 provisional ballots that had yet to be counted. Dr. Bera’s CA-7 district race proved to be the most expensive in the nation with an estimated $19.6 million in total expenditures. Despite representing only 0.51% of that total, SurgeonsPAC’s contribution, in the collective with that of other physician organizations, no doubt played a significant role in returning a physician to Congress to continue to champion our causes.
In my opinion, these examples of careful candidate selection and subsequent support of Drs. Benishek and Bera exemplify the importance of a strong political action committee. The ultimate goal of SurgeonsPAC is the election to Congress and retention in Congress of those who support our policy positions and legislative agenda. Though SurgeonsPAC is one of nine physician PACs that can be accurately labeled as “million dollar” (per election cycle) PACs, our relative size and, thus, the number of candidates like Drs. Bera and Benishek we could support would be much greater if the Fellow participation rate more closely resembled that of our colleagues in other physician organizations. However, year after year, only 3%-4% of Fellows contribute, as compared with participation rates of 10%-25% in those physician PACs larger than SurgeonsPAC.
Recently, all Fellows received an e-mail from Dr. Andrew Warshaw, founding SurgeonsPAC Board Chairman and current President of the ACS, urging Fellows to make a $25 donation to SurgeonsPAC. Those wishing to learn more about the critical role SurgeonsPAC plays in our advocacy efforts can log on to www.surgeonspac.org.
Until next month...
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Rural cancer care – if you build it (and measure it!), they will come
Rural surgeons who provide cancer care face a particular set of challenges. Rural patients tend to be older, sicker, less educated and economically disadvantaged. Rural areas have a higher prevalence of chronic diseases including heart disease and cancer. Rural patients present with more advanced cancers than their urban counterparts. Specific rural regions (i.e., Appalachia) have documented higher cancer incidences and mortality rates.
In addition, there are several barriers to providing cancer care for rural populations. These include poor access to health care services and specialists; geographic barriers preventing access to providers, services, and technology; minimal transportation options for either cancer screening or treatment; limited knowledge of cancer and low participation in screening and other healthy practices; prohibitive costs of screening and cancer treatment; and, in some cases, suboptimal care provided to cancer patients (J. Am. Coll. Surg. 2014;219:814-8; Gosschalk, A. and Carozza, S., “Cancer in rural areas: A literature review,” Rural Healthy People 2010, Vol. 2 [College Station: The Texas A&M University System Health Science Center, 2003]).
Several examples of suboptimal care for rural cancer patients have appeared in professional journals and meetings and in the lay press. Examples of rural cancer care inadequacies include lower use of needle biopsy and sentinel lymph node biopsy techniques for breast cancer patients (Am. J. Surg. 2014;208:382-90; Am. J. Surg. 2013;206:674-81; ACS Surgery News, “Use of minimally invasive biopsy lags in Texas,” February 2013, p. 15); significantly lower rates of radiation treatment in breast lumpectomy patients (USA Today, Nov. 18, 2012); lower rates of adequate lymph node dissection, appropriate chemotherapy, and higher death rates in colon cancer patients (Chow, C.J., ACS Clinical Congress Presentation 2012); higher mastectomy rates and later-stage cancers in breast cancer patients (Jethwa, K., AACR Annual Conference Presentation 2013); higher likelihood of discharge to a skilled nursing facility instead of home in colon cancer patients; and the list goes on and on. These articles all come from academic centers through database studies. It is rare indeed to see data collected and published by the rural centers and providers actually caring for rural cancer patients.
My personal bias is that rural surgeons provide very competent, compassionate, high quality care that allows the cancer patient to remain close to their homes and support systems. This opinion has been reinforced by my involvement with the ACS Advisory Council on Rural Surgery, the rural listserve /ACS Rural Community and through my interaction with surgeons across the country at ACS Chapter meetings and at the Congress.
A study done by Finlayson (Med. Care 1999;37:204-9) documented that nearly 100% of rural patients preferred to receive their care locally, especially if the quality of care was the same as the larger distant hospital. In fact, nearly half of the patients polled would choose to remain local even if the mortality rate at the local hospital was double that of a hospital requiring the patient to travel for care. More recent papers however suggest that patients may be bypassing their local hospitals for care because of concerns about the quality of care provided locally (J. Rural Health 1999;10:70-9; J. Rural Health 2007;23:17-24).
A 2013 ASCO presentation documented that General Surgeons perform a majority of cancer surgeries in the United States (Stizenberg, K.; SSO 66th Annual Cancer Symposium; Abstract 75, March 8, 2013). Only 303 (< 8%) counties in the United States even have a surgical oncologist. A 2014 ASCO presentation estimated a 43% increase in inpatient oncology procedures and a 25% increase in outpatient procedures between 2002 and 2020. By 2025 the total demand for oncology care will rise by 43% (ASCO, “The state of cancer care 2014,” J. Oncol. Prac. 2014;10:119-42). Another study (ACS Surgery News, “Surgeon supply to drop 18% by 2028,” January 2013, p. 1) has estimated that, with predicted future surgeon shortages, general surgeons will be called upon to perform 25% of cases now done by other surgical specialists. General surgeons, both rural and urban, are clearly providing the bulk of cancer care to patients and this trend is on the rise in coming years.
Rural surgeons have certain barriers that prevent them from measuring, documenting, and publicizing the specifics of the care provided to their patients. These surgeons often are in single or small group practices and manage their own businesses. They have no office or hospital staff dedicated to quality endeavors. Financial and time constraints prevent them from being champions of quality care in their communities. Additionally, small numbers of specific cases can result in high statistical complication and mortality rates even if these events happen infrequently. This inability to collect data and assess the quality of care provided can lead to patient outmigration and even “tiering” by third-party payers that forces patients away from their hometown hospitals and providers using financial disincentives.
Rural surgeons can and must now take the lead in collecting, assessing, and reporting data about the care they provide for their communities. This process can be in the form of standardized programs like ACS Rural National Surgical Quality Improvement Program (NSQIP), Surgical Care Improvement Project (SCIP), or Commission on Cancer (CoC) accreditation involvement. Smaller institutions with a single surgeon may not have the financial and staff resources to formally participate but each surgeon can assess what makes up the majority of his or her caseload, whether that is endoscopy or breast or colon cases, and find national benchmarks that can easily be measured. Every endoscopy department can collect data on cecal intubation rates, withdrawal times, adequacy of preps, adenoma detection rates, and appropriate follow-up intervals. Individual surgeons can pick and chose specific benchmarks from NSQIP, Commission on Cancer, National Accreditation Program for Breast Centers (NAPBC), or ACS Committee on Trauma standards documents and use these to evaluate the care they provide. Easy examples might include number of lymph nodes harvested at colon cancer surgery, percentage of breast cancer patients diagnosed with needle biopsy, and percentage treated with conservative surgery and appropriate postop radiation and or chemotherapy, or the percentage of melanoma patients treated per National Comprehensive Cancer Network guidelines. Other ways for institutions to document quality might be to partner with their tertiary referral center for CoC accreditation or just to participate in cancer conferences by videoconferencing. The Commission on Cancer has designated CoC Liason Program Chairs in each state that are available to aid in setting up these types of programs.
It is time for rural surgeons to partner with their hospitals and communities to carry out needs assessments and think of ways to fill those needs. An example might be to work with primary care providers to develop aggressive colon, breast, or lung cancer screening programs in communities with high numbers of late-stage cases. Transparency of the data collected and the care provided in the form of “Quality Reports to the Community” can improve local referral patterns, improve the financial viability of the local hospital, and prove to the community that quality care is being rendered. Pooling the data from a large base of rural surgeons could serve to disprove the academic community notion that rural patients receive suboptimal cancer care.
Dr. Sarap is a practicing general surgeon in Cambridge, Ohio. He is a member of the Advisory Council on Rural Surgery and has been appointed the Commission on Cancer Liaison Program Chair for Ohio.
Rural surgeons who provide cancer care face a particular set of challenges. Rural patients tend to be older, sicker, less educated and economically disadvantaged. Rural areas have a higher prevalence of chronic diseases including heart disease and cancer. Rural patients present with more advanced cancers than their urban counterparts. Specific rural regions (i.e., Appalachia) have documented higher cancer incidences and mortality rates.
In addition, there are several barriers to providing cancer care for rural populations. These include poor access to health care services and specialists; geographic barriers preventing access to providers, services, and technology; minimal transportation options for either cancer screening or treatment; limited knowledge of cancer and low participation in screening and other healthy practices; prohibitive costs of screening and cancer treatment; and, in some cases, suboptimal care provided to cancer patients (J. Am. Coll. Surg. 2014;219:814-8; Gosschalk, A. and Carozza, S., “Cancer in rural areas: A literature review,” Rural Healthy People 2010, Vol. 2 [College Station: The Texas A&M University System Health Science Center, 2003]).
Several examples of suboptimal care for rural cancer patients have appeared in professional journals and meetings and in the lay press. Examples of rural cancer care inadequacies include lower use of needle biopsy and sentinel lymph node biopsy techniques for breast cancer patients (Am. J. Surg. 2014;208:382-90; Am. J. Surg. 2013;206:674-81; ACS Surgery News, “Use of minimally invasive biopsy lags in Texas,” February 2013, p. 15); significantly lower rates of radiation treatment in breast lumpectomy patients (USA Today, Nov. 18, 2012); lower rates of adequate lymph node dissection, appropriate chemotherapy, and higher death rates in colon cancer patients (Chow, C.J., ACS Clinical Congress Presentation 2012); higher mastectomy rates and later-stage cancers in breast cancer patients (Jethwa, K., AACR Annual Conference Presentation 2013); higher likelihood of discharge to a skilled nursing facility instead of home in colon cancer patients; and the list goes on and on. These articles all come from academic centers through database studies. It is rare indeed to see data collected and published by the rural centers and providers actually caring for rural cancer patients.
My personal bias is that rural surgeons provide very competent, compassionate, high quality care that allows the cancer patient to remain close to their homes and support systems. This opinion has been reinforced by my involvement with the ACS Advisory Council on Rural Surgery, the rural listserve /ACS Rural Community and through my interaction with surgeons across the country at ACS Chapter meetings and at the Congress.
A study done by Finlayson (Med. Care 1999;37:204-9) documented that nearly 100% of rural patients preferred to receive their care locally, especially if the quality of care was the same as the larger distant hospital. In fact, nearly half of the patients polled would choose to remain local even if the mortality rate at the local hospital was double that of a hospital requiring the patient to travel for care. More recent papers however suggest that patients may be bypassing their local hospitals for care because of concerns about the quality of care provided locally (J. Rural Health 1999;10:70-9; J. Rural Health 2007;23:17-24).
A 2013 ASCO presentation documented that General Surgeons perform a majority of cancer surgeries in the United States (Stizenberg, K.; SSO 66th Annual Cancer Symposium; Abstract 75, March 8, 2013). Only 303 (< 8%) counties in the United States even have a surgical oncologist. A 2014 ASCO presentation estimated a 43% increase in inpatient oncology procedures and a 25% increase in outpatient procedures between 2002 and 2020. By 2025 the total demand for oncology care will rise by 43% (ASCO, “The state of cancer care 2014,” J. Oncol. Prac. 2014;10:119-42). Another study (ACS Surgery News, “Surgeon supply to drop 18% by 2028,” January 2013, p. 1) has estimated that, with predicted future surgeon shortages, general surgeons will be called upon to perform 25% of cases now done by other surgical specialists. General surgeons, both rural and urban, are clearly providing the bulk of cancer care to patients and this trend is on the rise in coming years.
Rural surgeons have certain barriers that prevent them from measuring, documenting, and publicizing the specifics of the care provided to their patients. These surgeons often are in single or small group practices and manage their own businesses. They have no office or hospital staff dedicated to quality endeavors. Financial and time constraints prevent them from being champions of quality care in their communities. Additionally, small numbers of specific cases can result in high statistical complication and mortality rates even if these events happen infrequently. This inability to collect data and assess the quality of care provided can lead to patient outmigration and even “tiering” by third-party payers that forces patients away from their hometown hospitals and providers using financial disincentives.
Rural surgeons can and must now take the lead in collecting, assessing, and reporting data about the care they provide for their communities. This process can be in the form of standardized programs like ACS Rural National Surgical Quality Improvement Program (NSQIP), Surgical Care Improvement Project (SCIP), or Commission on Cancer (CoC) accreditation involvement. Smaller institutions with a single surgeon may not have the financial and staff resources to formally participate but each surgeon can assess what makes up the majority of his or her caseload, whether that is endoscopy or breast or colon cases, and find national benchmarks that can easily be measured. Every endoscopy department can collect data on cecal intubation rates, withdrawal times, adequacy of preps, adenoma detection rates, and appropriate follow-up intervals. Individual surgeons can pick and chose specific benchmarks from NSQIP, Commission on Cancer, National Accreditation Program for Breast Centers (NAPBC), or ACS Committee on Trauma standards documents and use these to evaluate the care they provide. Easy examples might include number of lymph nodes harvested at colon cancer surgery, percentage of breast cancer patients diagnosed with needle biopsy, and percentage treated with conservative surgery and appropriate postop radiation and or chemotherapy, or the percentage of melanoma patients treated per National Comprehensive Cancer Network guidelines. Other ways for institutions to document quality might be to partner with their tertiary referral center for CoC accreditation or just to participate in cancer conferences by videoconferencing. The Commission on Cancer has designated CoC Liason Program Chairs in each state that are available to aid in setting up these types of programs.
It is time for rural surgeons to partner with their hospitals and communities to carry out needs assessments and think of ways to fill those needs. An example might be to work with primary care providers to develop aggressive colon, breast, or lung cancer screening programs in communities with high numbers of late-stage cases. Transparency of the data collected and the care provided in the form of “Quality Reports to the Community” can improve local referral patterns, improve the financial viability of the local hospital, and prove to the community that quality care is being rendered. Pooling the data from a large base of rural surgeons could serve to disprove the academic community notion that rural patients receive suboptimal cancer care.
Dr. Sarap is a practicing general surgeon in Cambridge, Ohio. He is a member of the Advisory Council on Rural Surgery and has been appointed the Commission on Cancer Liaison Program Chair for Ohio.
Rural surgeons who provide cancer care face a particular set of challenges. Rural patients tend to be older, sicker, less educated and economically disadvantaged. Rural areas have a higher prevalence of chronic diseases including heart disease and cancer. Rural patients present with more advanced cancers than their urban counterparts. Specific rural regions (i.e., Appalachia) have documented higher cancer incidences and mortality rates.
In addition, there are several barriers to providing cancer care for rural populations. These include poor access to health care services and specialists; geographic barriers preventing access to providers, services, and technology; minimal transportation options for either cancer screening or treatment; limited knowledge of cancer and low participation in screening and other healthy practices; prohibitive costs of screening and cancer treatment; and, in some cases, suboptimal care provided to cancer patients (J. Am. Coll. Surg. 2014;219:814-8; Gosschalk, A. and Carozza, S., “Cancer in rural areas: A literature review,” Rural Healthy People 2010, Vol. 2 [College Station: The Texas A&M University System Health Science Center, 2003]).
Several examples of suboptimal care for rural cancer patients have appeared in professional journals and meetings and in the lay press. Examples of rural cancer care inadequacies include lower use of needle biopsy and sentinel lymph node biopsy techniques for breast cancer patients (Am. J. Surg. 2014;208:382-90; Am. J. Surg. 2013;206:674-81; ACS Surgery News, “Use of minimally invasive biopsy lags in Texas,” February 2013, p. 15); significantly lower rates of radiation treatment in breast lumpectomy patients (USA Today, Nov. 18, 2012); lower rates of adequate lymph node dissection, appropriate chemotherapy, and higher death rates in colon cancer patients (Chow, C.J., ACS Clinical Congress Presentation 2012); higher mastectomy rates and later-stage cancers in breast cancer patients (Jethwa, K., AACR Annual Conference Presentation 2013); higher likelihood of discharge to a skilled nursing facility instead of home in colon cancer patients; and the list goes on and on. These articles all come from academic centers through database studies. It is rare indeed to see data collected and published by the rural centers and providers actually caring for rural cancer patients.
My personal bias is that rural surgeons provide very competent, compassionate, high quality care that allows the cancer patient to remain close to their homes and support systems. This opinion has been reinforced by my involvement with the ACS Advisory Council on Rural Surgery, the rural listserve /ACS Rural Community and through my interaction with surgeons across the country at ACS Chapter meetings and at the Congress.
A study done by Finlayson (Med. Care 1999;37:204-9) documented that nearly 100% of rural patients preferred to receive their care locally, especially if the quality of care was the same as the larger distant hospital. In fact, nearly half of the patients polled would choose to remain local even if the mortality rate at the local hospital was double that of a hospital requiring the patient to travel for care. More recent papers however suggest that patients may be bypassing their local hospitals for care because of concerns about the quality of care provided locally (J. Rural Health 1999;10:70-9; J. Rural Health 2007;23:17-24).
A 2013 ASCO presentation documented that General Surgeons perform a majority of cancer surgeries in the United States (Stizenberg, K.; SSO 66th Annual Cancer Symposium; Abstract 75, March 8, 2013). Only 303 (< 8%) counties in the United States even have a surgical oncologist. A 2014 ASCO presentation estimated a 43% increase in inpatient oncology procedures and a 25% increase in outpatient procedures between 2002 and 2020. By 2025 the total demand for oncology care will rise by 43% (ASCO, “The state of cancer care 2014,” J. Oncol. Prac. 2014;10:119-42). Another study (ACS Surgery News, “Surgeon supply to drop 18% by 2028,” January 2013, p. 1) has estimated that, with predicted future surgeon shortages, general surgeons will be called upon to perform 25% of cases now done by other surgical specialists. General surgeons, both rural and urban, are clearly providing the bulk of cancer care to patients and this trend is on the rise in coming years.
Rural surgeons have certain barriers that prevent them from measuring, documenting, and publicizing the specifics of the care provided to their patients. These surgeons often are in single or small group practices and manage their own businesses. They have no office or hospital staff dedicated to quality endeavors. Financial and time constraints prevent them from being champions of quality care in their communities. Additionally, small numbers of specific cases can result in high statistical complication and mortality rates even if these events happen infrequently. This inability to collect data and assess the quality of care provided can lead to patient outmigration and even “tiering” by third-party payers that forces patients away from their hometown hospitals and providers using financial disincentives.
Rural surgeons can and must now take the lead in collecting, assessing, and reporting data about the care they provide for their communities. This process can be in the form of standardized programs like ACS Rural National Surgical Quality Improvement Program (NSQIP), Surgical Care Improvement Project (SCIP), or Commission on Cancer (CoC) accreditation involvement. Smaller institutions with a single surgeon may not have the financial and staff resources to formally participate but each surgeon can assess what makes up the majority of his or her caseload, whether that is endoscopy or breast or colon cases, and find national benchmarks that can easily be measured. Every endoscopy department can collect data on cecal intubation rates, withdrawal times, adequacy of preps, adenoma detection rates, and appropriate follow-up intervals. Individual surgeons can pick and chose specific benchmarks from NSQIP, Commission on Cancer, National Accreditation Program for Breast Centers (NAPBC), or ACS Committee on Trauma standards documents and use these to evaluate the care they provide. Easy examples might include number of lymph nodes harvested at colon cancer surgery, percentage of breast cancer patients diagnosed with needle biopsy, and percentage treated with conservative surgery and appropriate postop radiation and or chemotherapy, or the percentage of melanoma patients treated per National Comprehensive Cancer Network guidelines. Other ways for institutions to document quality might be to partner with their tertiary referral center for CoC accreditation or just to participate in cancer conferences by videoconferencing. The Commission on Cancer has designated CoC Liason Program Chairs in each state that are available to aid in setting up these types of programs.
It is time for rural surgeons to partner with their hospitals and communities to carry out needs assessments and think of ways to fill those needs. An example might be to work with primary care providers to develop aggressive colon, breast, or lung cancer screening programs in communities with high numbers of late-stage cases. Transparency of the data collected and the care provided in the form of “Quality Reports to the Community” can improve local referral patterns, improve the financial viability of the local hospital, and prove to the community that quality care is being rendered. Pooling the data from a large base of rural surgeons could serve to disprove the academic community notion that rural patients receive suboptimal cancer care.
Dr. Sarap is a practicing general surgeon in Cambridge, Ohio. He is a member of the Advisory Council on Rural Surgery and has been appointed the Commission on Cancer Liaison Program Chair for Ohio.
Call for nominations for the American College of Surgeons Board of Regents
The 2015 Nominating Committee of the Board of Governors (NCBG) will select nominees for pending vacancies on the Board of Regents that will be filled at the 2015 Clinical Congress. The NCBG uses the following guidelines when reviewing the names of candidates for nomination to the Board of Regents:
•Nominees must be loyal members of the College who have demonstrated outstanding integrity and medical statesmanship, along with an unquestioned devotion to the highest principles of surgical practice.
•Nominees must have demonstrated leadership qualities that might be reflected by service and active participation on ACS committees or in other components of the College.
The NCBG recognizes the importance of Board of Regent members representing all health care professionals who practice surgery.
The NCBG also considers geography, surgical specialty balance, and academic or community practice.
The College encourages consideration of women and other underrepresented minorities. Individuals who are no longer in active surgical practice should not be nominated for election or reelection to the Board of Regents.All surgical specialties will be considered.
All nominations must include a letter of recommendation, a personal statement from the candidates detailing their ACS service, and the name of one reference. In addition, entities such as surgical specialty societies, ACS advisory councils, and ACS chapters that are submitting nominations must provide a description of their selection process and the total list of applicants reviewed. Any attempt to contact members of the NCBG by a candidate or on behalf of a candidate will be viewed in a negative manner and may result in disqualification of the candidate. Applications submitted without the requested information will not be considered.
The deadline for submitting nominations is February 27. Submit nominations to [email protected].
For more information, contact Betty Sanders, Staff Liaison for the NCBG, at 312-202-5360 or [email protected].
For information only, the current members of the Board of Regents who will be considered for re-election (all MD, FACS) are John L.D. Atkinson; Henri R. Ford; Enrique Hernandez; L. Scott Levin; Leigh A. Neumayer; Marshall Z. Schwartz; Beth H. Sutton; and Steven D. Wexner.
The 2015 Nominating Committee of the Board of Governors (NCBG) will select nominees for pending vacancies on the Board of Regents that will be filled at the 2015 Clinical Congress. The NCBG uses the following guidelines when reviewing the names of candidates for nomination to the Board of Regents:
•Nominees must be loyal members of the College who have demonstrated outstanding integrity and medical statesmanship, along with an unquestioned devotion to the highest principles of surgical practice.
•Nominees must have demonstrated leadership qualities that might be reflected by service and active participation on ACS committees or in other components of the College.
The NCBG recognizes the importance of Board of Regent members representing all health care professionals who practice surgery.
The NCBG also considers geography, surgical specialty balance, and academic or community practice.
The College encourages consideration of women and other underrepresented minorities. Individuals who are no longer in active surgical practice should not be nominated for election or reelection to the Board of Regents.All surgical specialties will be considered.
All nominations must include a letter of recommendation, a personal statement from the candidates detailing their ACS service, and the name of one reference. In addition, entities such as surgical specialty societies, ACS advisory councils, and ACS chapters that are submitting nominations must provide a description of their selection process and the total list of applicants reviewed. Any attempt to contact members of the NCBG by a candidate or on behalf of a candidate will be viewed in a negative manner and may result in disqualification of the candidate. Applications submitted without the requested information will not be considered.
The deadline for submitting nominations is February 27. Submit nominations to [email protected].
For more information, contact Betty Sanders, Staff Liaison for the NCBG, at 312-202-5360 or [email protected].
For information only, the current members of the Board of Regents who will be considered for re-election (all MD, FACS) are John L.D. Atkinson; Henri R. Ford; Enrique Hernandez; L. Scott Levin; Leigh A. Neumayer; Marshall Z. Schwartz; Beth H. Sutton; and Steven D. Wexner.
The 2015 Nominating Committee of the Board of Governors (NCBG) will select nominees for pending vacancies on the Board of Regents that will be filled at the 2015 Clinical Congress. The NCBG uses the following guidelines when reviewing the names of candidates for nomination to the Board of Regents:
•Nominees must be loyal members of the College who have demonstrated outstanding integrity and medical statesmanship, along with an unquestioned devotion to the highest principles of surgical practice.
•Nominees must have demonstrated leadership qualities that might be reflected by service and active participation on ACS committees or in other components of the College.
The NCBG recognizes the importance of Board of Regent members representing all health care professionals who practice surgery.
The NCBG also considers geography, surgical specialty balance, and academic or community practice.
The College encourages consideration of women and other underrepresented minorities. Individuals who are no longer in active surgical practice should not be nominated for election or reelection to the Board of Regents.All surgical specialties will be considered.
All nominations must include a letter of recommendation, a personal statement from the candidates detailing their ACS service, and the name of one reference. In addition, entities such as surgical specialty societies, ACS advisory councils, and ACS chapters that are submitting nominations must provide a description of their selection process and the total list of applicants reviewed. Any attempt to contact members of the NCBG by a candidate or on behalf of a candidate will be viewed in a negative manner and may result in disqualification of the candidate. Applications submitted without the requested information will not be considered.
The deadline for submitting nominations is February 27. Submit nominations to [email protected].
For more information, contact Betty Sanders, Staff Liaison for the NCBG, at 312-202-5360 or [email protected].
For information only, the current members of the Board of Regents who will be considered for re-election (all MD, FACS) are John L.D. Atkinson; Henri R. Ford; Enrique Hernandez; L. Scott Levin; Leigh A. Neumayer; Marshall Z. Schwartz; Beth H. Sutton; and Steven D. Wexner.
Call for nominations for ACS Officers-Elect
The 2015 Nominating Committee of the Fellows (NCF) will select nominees for the three Officer-Elect positions of the American College of Surgeons (ACS): President-Elect, First Vice-President Elect, and Second Vice-President Elect. The NCF will use the following guidelines when considering potential candidates:
•Nominees must be loyal members of the College who have demonstrated outstanding integrity and medical statesmanship, along with an unquestioned devotion to the highest principles of surgical practice.
•Nominees must have demonstrated leadership qualities that might be reflected by service and active participation on ACS committees or in other components of the College.
Members of the Nominating Committee recognize the importance of achieving representation of all who practice surgery.
The College encourages consideration of women and other underrepresented minorities.
All nominations must include the following:
•A letter of recommendation
•A personal statement from the candidate detailing ACS service (for President-Elect position only)
•A current curriculum vitae
•The name of one individual who can serve as a reference
In addition, nominating entities, such as surgical special societies, ACS advisory councils, and ACS chapters, must provide a description of their selection process and the total list of applicants reviewed. Any attempt to contact members of the NCF by a candidate or on behalf of a candidate will be viewed negatively and may result in disqualification. Applications submitted without the requested information will not be considered.
The deadline for submitting nominations is February 27. Submit nominations to [email protected]. If you have questions, contact Betty Sanders, staff liaison for the NCF, at 312-202-5360 or [email protected].
The 2015 Nominating Committee of the Fellows (NCF) will select nominees for the three Officer-Elect positions of the American College of Surgeons (ACS): President-Elect, First Vice-President Elect, and Second Vice-President Elect. The NCF will use the following guidelines when considering potential candidates:
•Nominees must be loyal members of the College who have demonstrated outstanding integrity and medical statesmanship, along with an unquestioned devotion to the highest principles of surgical practice.
•Nominees must have demonstrated leadership qualities that might be reflected by service and active participation on ACS committees or in other components of the College.
Members of the Nominating Committee recognize the importance of achieving representation of all who practice surgery.
The College encourages consideration of women and other underrepresented minorities.
All nominations must include the following:
•A letter of recommendation
•A personal statement from the candidate detailing ACS service (for President-Elect position only)
•A current curriculum vitae
•The name of one individual who can serve as a reference
In addition, nominating entities, such as surgical special societies, ACS advisory councils, and ACS chapters, must provide a description of their selection process and the total list of applicants reviewed. Any attempt to contact members of the NCF by a candidate or on behalf of a candidate will be viewed negatively and may result in disqualification. Applications submitted without the requested information will not be considered.
The deadline for submitting nominations is February 27. Submit nominations to [email protected]. If you have questions, contact Betty Sanders, staff liaison for the NCF, at 312-202-5360 or [email protected].
The 2015 Nominating Committee of the Fellows (NCF) will select nominees for the three Officer-Elect positions of the American College of Surgeons (ACS): President-Elect, First Vice-President Elect, and Second Vice-President Elect. The NCF will use the following guidelines when considering potential candidates:
•Nominees must be loyal members of the College who have demonstrated outstanding integrity and medical statesmanship, along with an unquestioned devotion to the highest principles of surgical practice.
•Nominees must have demonstrated leadership qualities that might be reflected by service and active participation on ACS committees or in other components of the College.
Members of the Nominating Committee recognize the importance of achieving representation of all who practice surgery.
The College encourages consideration of women and other underrepresented minorities.
All nominations must include the following:
•A letter of recommendation
•A personal statement from the candidate detailing ACS service (for President-Elect position only)
•A current curriculum vitae
•The name of one individual who can serve as a reference
In addition, nominating entities, such as surgical special societies, ACS advisory councils, and ACS chapters, must provide a description of their selection process and the total list of applicants reviewed. Any attempt to contact members of the NCF by a candidate or on behalf of a candidate will be viewed negatively and may result in disqualification. Applications submitted without the requested information will not be considered.
The deadline for submitting nominations is February 27. Submit nominations to [email protected]. If you have questions, contact Betty Sanders, staff liaison for the NCF, at 312-202-5360 or [email protected].
Nominations for 2015 volunteerism and humanitarian awards due February 27
The American College of Surgeons (ACS), in association with Pfizer, Inc., is accepting nominations for the 2015 Surgical Volunteerism Award(s) and Surgical Humanitarian Award. All nominations must be received by February 27.
Volunteerism Awards
The ACS/Pfizer Surgical Volunteerism Award—offered annually in four potential categories—recognizes surgeons who are committed to giving back to society by making significant contributions to surgical care through organized volunteer activities. The awards for domestic, international, and military outreach are intended for ACS Fellows in active surgical practice whose volunteer activities go above and beyond the usual professional commitments, or retired Fellows who have been involved in volunteerism during their active practice and into retirement. Resident Members and Associate Fellows of the College who have been involved in significant surgical volunteer activities during their postgraduate surgical training are eligible for the Resident award. Surgeons of all specialties are eligible for each of these awards.
For the purposes of these awards, “volunteerism” is defined as professional work in which one’s time or talents are donated for charitable clinical, educational, or other worthwhile activities related to surgery. Volunteerism, in this case, does not refer to uncompensated care provided as a matter of necessity in most clinical practices. Instead, volunteerism should be characterized by prospective, planned surgical care to underserved patients with no anticipation of reimbursement or economic gain.
Humanitarian Award
The ACS/Pfizer Surgical Humanitarian Award recognizes an ACS Fellow whose career has been dedicated to ensuring the provision of surgical care to underserved populations without expectation of commensurate reimbursement.
This award is intended for surgeons who have dedicated a significant portion of their surgical careers to full-time or near full-time humanitarian efforts, rather than routine surgical practice. Examples include a career centered on missionary surgery, the founding and ongoing operations of a charitable organization dedicated to providing surgical care to the underserved, or a retirement characterized by surgical volunteer outreach.
Having received compensation for this work does not preclude a nominee from consideration and, in fact, may be expected based on the extent of the professional obligation.
The ACS Board of Governors’ Surgical Volunteerism and Humanitarian Awards Workgroup will evaluate the nominations and forward their selections to the Board of Governors’ Executive Committee for final approval.
Nominations
The following conditions apply to the nominations process:
•Self-nominations are permissible but require at least one outside letter of support.
•Re-nomination of previous nominees is acceptable but requires completion of a new application.
For the nominee to have a fair review, detailed information is required, including the following:
•Demographic information about the nominee and nominator
•Details about the nominator’s relationship to the nominee, along with background information on the nominee’s career in surgery
•Completion of seven sections of information related to the nominee’s volunteerism or humanitarian work (minimum 250-word descriptions are required for each section that is applicable to the nominee)Additional materials may be submitted; however, information included in the nomination form itself will take precedence in the evaluation process, so fill out the form in its entirety. If you cannot complete the nomination form in one sitting, you can save the form and complete it at another time. The nomination website opens January 6 for electronic submissions and can be accessed through the “Announcements” section of the Operation Giving Back (OGB) website at http://www.operationgivingback.facs.org, or via www.facs.org/member-services/volunteer. Contact OGB at [email protected].
The American College of Surgeons (ACS), in association with Pfizer, Inc., is accepting nominations for the 2015 Surgical Volunteerism Award(s) and Surgical Humanitarian Award. All nominations must be received by February 27.
Volunteerism Awards
The ACS/Pfizer Surgical Volunteerism Award—offered annually in four potential categories—recognizes surgeons who are committed to giving back to society by making significant contributions to surgical care through organized volunteer activities. The awards for domestic, international, and military outreach are intended for ACS Fellows in active surgical practice whose volunteer activities go above and beyond the usual professional commitments, or retired Fellows who have been involved in volunteerism during their active practice and into retirement. Resident Members and Associate Fellows of the College who have been involved in significant surgical volunteer activities during their postgraduate surgical training are eligible for the Resident award. Surgeons of all specialties are eligible for each of these awards.
For the purposes of these awards, “volunteerism” is defined as professional work in which one’s time or talents are donated for charitable clinical, educational, or other worthwhile activities related to surgery. Volunteerism, in this case, does not refer to uncompensated care provided as a matter of necessity in most clinical practices. Instead, volunteerism should be characterized by prospective, planned surgical care to underserved patients with no anticipation of reimbursement or economic gain.
Humanitarian Award
The ACS/Pfizer Surgical Humanitarian Award recognizes an ACS Fellow whose career has been dedicated to ensuring the provision of surgical care to underserved populations without expectation of commensurate reimbursement.
This award is intended for surgeons who have dedicated a significant portion of their surgical careers to full-time or near full-time humanitarian efforts, rather than routine surgical practice. Examples include a career centered on missionary surgery, the founding and ongoing operations of a charitable organization dedicated to providing surgical care to the underserved, or a retirement characterized by surgical volunteer outreach.
Having received compensation for this work does not preclude a nominee from consideration and, in fact, may be expected based on the extent of the professional obligation.
The ACS Board of Governors’ Surgical Volunteerism and Humanitarian Awards Workgroup will evaluate the nominations and forward their selections to the Board of Governors’ Executive Committee for final approval.
Nominations
The following conditions apply to the nominations process:
•Self-nominations are permissible but require at least one outside letter of support.
•Re-nomination of previous nominees is acceptable but requires completion of a new application.
For the nominee to have a fair review, detailed information is required, including the following:
•Demographic information about the nominee and nominator
•Details about the nominator’s relationship to the nominee, along with background information on the nominee’s career in surgery
•Completion of seven sections of information related to the nominee’s volunteerism or humanitarian work (minimum 250-word descriptions are required for each section that is applicable to the nominee)Additional materials may be submitted; however, information included in the nomination form itself will take precedence in the evaluation process, so fill out the form in its entirety. If you cannot complete the nomination form in one sitting, you can save the form and complete it at another time. The nomination website opens January 6 for electronic submissions and can be accessed through the “Announcements” section of the Operation Giving Back (OGB) website at http://www.operationgivingback.facs.org, or via www.facs.org/member-services/volunteer. Contact OGB at [email protected].
The American College of Surgeons (ACS), in association with Pfizer, Inc., is accepting nominations for the 2015 Surgical Volunteerism Award(s) and Surgical Humanitarian Award. All nominations must be received by February 27.
Volunteerism Awards
The ACS/Pfizer Surgical Volunteerism Award—offered annually in four potential categories—recognizes surgeons who are committed to giving back to society by making significant contributions to surgical care through organized volunteer activities. The awards for domestic, international, and military outreach are intended for ACS Fellows in active surgical practice whose volunteer activities go above and beyond the usual professional commitments, or retired Fellows who have been involved in volunteerism during their active practice and into retirement. Resident Members and Associate Fellows of the College who have been involved in significant surgical volunteer activities during their postgraduate surgical training are eligible for the Resident award. Surgeons of all specialties are eligible for each of these awards.
For the purposes of these awards, “volunteerism” is defined as professional work in which one’s time or talents are donated for charitable clinical, educational, or other worthwhile activities related to surgery. Volunteerism, in this case, does not refer to uncompensated care provided as a matter of necessity in most clinical practices. Instead, volunteerism should be characterized by prospective, planned surgical care to underserved patients with no anticipation of reimbursement or economic gain.
Humanitarian Award
The ACS/Pfizer Surgical Humanitarian Award recognizes an ACS Fellow whose career has been dedicated to ensuring the provision of surgical care to underserved populations without expectation of commensurate reimbursement.
This award is intended for surgeons who have dedicated a significant portion of their surgical careers to full-time or near full-time humanitarian efforts, rather than routine surgical practice. Examples include a career centered on missionary surgery, the founding and ongoing operations of a charitable organization dedicated to providing surgical care to the underserved, or a retirement characterized by surgical volunteer outreach.
Having received compensation for this work does not preclude a nominee from consideration and, in fact, may be expected based on the extent of the professional obligation.
The ACS Board of Governors’ Surgical Volunteerism and Humanitarian Awards Workgroup will evaluate the nominations and forward their selections to the Board of Governors’ Executive Committee for final approval.
Nominations
The following conditions apply to the nominations process:
•Self-nominations are permissible but require at least one outside letter of support.
•Re-nomination of previous nominees is acceptable but requires completion of a new application.
For the nominee to have a fair review, detailed information is required, including the following:
•Demographic information about the nominee and nominator
•Details about the nominator’s relationship to the nominee, along with background information on the nominee’s career in surgery
•Completion of seven sections of information related to the nominee’s volunteerism or humanitarian work (minimum 250-word descriptions are required for each section that is applicable to the nominee)Additional materials may be submitted; however, information included in the nomination form itself will take precedence in the evaluation process, so fill out the form in its entirety. If you cannot complete the nomination form in one sitting, you can save the form and complete it at another time. The nomination website opens January 6 for electronic submissions and can be accessed through the “Announcements” section of the Operation Giving Back (OGB) website at http://www.operationgivingback.facs.org, or via www.facs.org/member-services/volunteer. Contact OGB at [email protected].
New ACS initiative will highlight the importance of education and training
To keep pace with rapidly evolving science, technology, knowledge, and techniques over the course of a long career, surgeons need a trusted partner to teach them what they need to know in the way they prefer to learn. The American College of Surgeons (ACS), well-positioned as a principal source of knowledge and skills, has more than a century of experience with testing and validating what works in surgical education and has access to top faculty and the latest technology.
The American College of Surgeons (ACS) launched an initiative at Clinical Congress 2014 to help surgeons embrace the joy of learning and identify state-of-the-art, relevant, and inspiring education and training opportunities. Surgeons can partner with the ACS throughout their careers, starting with the earliest stages and continuing through years of practice.
The campaign’s messaging will focus on three key points:
•ACS Education and Training programs are the cornerstones of excellence in surgical patient care.
•ACS Education and Training programs transform possibilities into realities.
•ACS Education and Training programs instill the joy of lifelong learning.
The overarching aim of the campaign is to support the needs of individual surgeons across a lifetime of practice and to highlight the critical importance of ACS Education and Training to accomplish the following:
•Increase participation in College education programs and products
•Build awareness of ACS’ leadership and innovation in education
•Help surgeons make informed decisions about their investment in education and training
•Promote surgical care of the highest quality and patient safety
•Make it easier for surgeons to participate in the joy and rewards of lifelong learningTo capture how ACS Education and Training serve as cornerstones of excellence, and transform possibilities into realities, the College created an animated text video, available at https://www.youtube.com/watch?v=rPBYGQPJtcs/. To learn more about the ACS Education and Training opportunities, view the video, read the November 2014 issue of the Bulletin’s Looking Forward column at http://bulletin.facs.org/2014/11/looking-forward-november-2014/ by ACS Executive Director David B. Hoyt, MD, FACS, and visit the ACS Education webpage at https://www.facs.org/education.
To keep pace with rapidly evolving science, technology, knowledge, and techniques over the course of a long career, surgeons need a trusted partner to teach them what they need to know in the way they prefer to learn. The American College of Surgeons (ACS), well-positioned as a principal source of knowledge and skills, has more than a century of experience with testing and validating what works in surgical education and has access to top faculty and the latest technology.
The American College of Surgeons (ACS) launched an initiative at Clinical Congress 2014 to help surgeons embrace the joy of learning and identify state-of-the-art, relevant, and inspiring education and training opportunities. Surgeons can partner with the ACS throughout their careers, starting with the earliest stages and continuing through years of practice.
The campaign’s messaging will focus on three key points:
•ACS Education and Training programs are the cornerstones of excellence in surgical patient care.
•ACS Education and Training programs transform possibilities into realities.
•ACS Education and Training programs instill the joy of lifelong learning.
The overarching aim of the campaign is to support the needs of individual surgeons across a lifetime of practice and to highlight the critical importance of ACS Education and Training to accomplish the following:
•Increase participation in College education programs and products
•Build awareness of ACS’ leadership and innovation in education
•Help surgeons make informed decisions about their investment in education and training
•Promote surgical care of the highest quality and patient safety
•Make it easier for surgeons to participate in the joy and rewards of lifelong learningTo capture how ACS Education and Training serve as cornerstones of excellence, and transform possibilities into realities, the College created an animated text video, available at https://www.youtube.com/watch?v=rPBYGQPJtcs/. To learn more about the ACS Education and Training opportunities, view the video, read the November 2014 issue of the Bulletin’s Looking Forward column at http://bulletin.facs.org/2014/11/looking-forward-november-2014/ by ACS Executive Director David B. Hoyt, MD, FACS, and visit the ACS Education webpage at https://www.facs.org/education.
To keep pace with rapidly evolving science, technology, knowledge, and techniques over the course of a long career, surgeons need a trusted partner to teach them what they need to know in the way they prefer to learn. The American College of Surgeons (ACS), well-positioned as a principal source of knowledge and skills, has more than a century of experience with testing and validating what works in surgical education and has access to top faculty and the latest technology.
The American College of Surgeons (ACS) launched an initiative at Clinical Congress 2014 to help surgeons embrace the joy of learning and identify state-of-the-art, relevant, and inspiring education and training opportunities. Surgeons can partner with the ACS throughout their careers, starting with the earliest stages and continuing through years of practice.
The campaign’s messaging will focus on three key points:
•ACS Education and Training programs are the cornerstones of excellence in surgical patient care.
•ACS Education and Training programs transform possibilities into realities.
•ACS Education and Training programs instill the joy of lifelong learning.
The overarching aim of the campaign is to support the needs of individual surgeons across a lifetime of practice and to highlight the critical importance of ACS Education and Training to accomplish the following:
•Increase participation in College education programs and products
•Build awareness of ACS’ leadership and innovation in education
•Help surgeons make informed decisions about their investment in education and training
•Promote surgical care of the highest quality and patient safety
•Make it easier for surgeons to participate in the joy and rewards of lifelong learningTo capture how ACS Education and Training serve as cornerstones of excellence, and transform possibilities into realities, the College created an animated text video, available at https://www.youtube.com/watch?v=rPBYGQPJtcs/. To learn more about the ACS Education and Training opportunities, view the video, read the November 2014 issue of the Bulletin’s Looking Forward column at http://bulletin.facs.org/2014/11/looking-forward-november-2014/ by ACS Executive Director David B. Hoyt, MD, FACS, and visit the ACS Education webpage at https://www.facs.org/education.
'The Talk'
The surgery chief resident texted me: “Patient in ED with peritonitis. Incarcerated hernia.”
I came to the ED; should be easy I thought. See the patient, have a short conversation since the chief resident would have done all the preop. Of course, things are rarely that simple.
First, she was a Jehovah’s Witness on warfarin with an INR of 4. More significantly, she had end-stage COPD. I reviewed her CT scan and labs and went to see her and could tell without any conversation she needed an operation. I needed more information, but not about her belly pain or when it started or whether she had peritonitis on exam. I needed to know how far she could walk, how much oxygen was she on at home, how much was she sleeping, how much weight had she lost, and could she leave the house.
It took 30 minutes to determine her functional status, whether she would survive the postoperative ICU care, whether she would come off the ventilator, and would she want a tracheostomy. It took another 15 minutes to discuss blood product use. Her husband was present, and I left them to decide what they wanted within the context of her goals for her life. She accepted some blood products, underwent surgery, and did well. She came off the ventilator quickly postop and returned home from the hospital. Although she did well, we had a plan for the ventilator and her goals of care defined should she have done poorly.
He was 72, had stage IV lung cancer, and was too weak for chemotherapy. Now he had free air and peritonitis. The referring institution called me and said he was too much for their surgeons. I suggested perhaps they needed to have “the talk” prior to transport. They were unwilling to do so and sent him by helicopter because he was hypotensive. He clearly needed an operation by all surgical standards. But I wanted to wait for his family and talk with them before taking him to the OR; he was in no condition for any component of informed consent.
The family arrived 30 minutes later. His wife, the daughters who had been helping to take care of him, and two more relatives that had just arrived in town. His wife was clear: The man was sleeping all the time, losing weight, barely eating a couple of bites, unsteady on his feet, and confused when he was awake. I discussed options: The surgeon part of me wanted to “fix the hole,” the ICU doc in me knew he would die in the ICU on a ventilator, and the palliative medicine part of me knew hospice was his best option. I told the family he needed surgery but would likely not leave the hospital alive. I recommended hospice.
The wife was thoughtful and looked at her daughters and said, “We need to send him to hospice.” The wife and daughters were the easiest family I have spoken with in a long time. She was clear about whet he wanted and how much he had declined in the past few months. We were able to get him to inpatient hospice from the ED.
Surgery has changed, at least in my practice. Oh, what would I give for a healthy 17-year-old with appendicitis who gets better within hours of the operating room and my conversation with the family that takes 10 seconds. Instead, I take care of the very old and the very sick and the very chronically ill. My conversations are not “you need surgery;” that is done by the chief resident. My conversations are “tell me your functional status and what do you want if/when things go poorly.” Much more complicated and much less fun. The surgeon wants to fix the hole. I can fix the hole. But have I really helped the patient and his or her family? Although it takes me longer and involves more of my emotions and skills, it really is better for the patients and their families to have “the talk.”
Next time you see a patient who is chronically ill, please have the conversation about functional status and goals of care, before you operate. Or transfer. Perhaps then we can save the patient a helicopter ride to hospice.
Dr. Toevs is a trauma critical care surgeon at Allegheny General Hospital in Pittsburgh. She has a master’s degree in bioethics and board certification in hospice and palliative medicine.
The surgery chief resident texted me: “Patient in ED with peritonitis. Incarcerated hernia.”
I came to the ED; should be easy I thought. See the patient, have a short conversation since the chief resident would have done all the preop. Of course, things are rarely that simple.
First, she was a Jehovah’s Witness on warfarin with an INR of 4. More significantly, she had end-stage COPD. I reviewed her CT scan and labs and went to see her and could tell without any conversation she needed an operation. I needed more information, but not about her belly pain or when it started or whether she had peritonitis on exam. I needed to know how far she could walk, how much oxygen was she on at home, how much was she sleeping, how much weight had she lost, and could she leave the house.
It took 30 minutes to determine her functional status, whether she would survive the postoperative ICU care, whether she would come off the ventilator, and would she want a tracheostomy. It took another 15 minutes to discuss blood product use. Her husband was present, and I left them to decide what they wanted within the context of her goals for her life. She accepted some blood products, underwent surgery, and did well. She came off the ventilator quickly postop and returned home from the hospital. Although she did well, we had a plan for the ventilator and her goals of care defined should she have done poorly.
He was 72, had stage IV lung cancer, and was too weak for chemotherapy. Now he had free air and peritonitis. The referring institution called me and said he was too much for their surgeons. I suggested perhaps they needed to have “the talk” prior to transport. They were unwilling to do so and sent him by helicopter because he was hypotensive. He clearly needed an operation by all surgical standards. But I wanted to wait for his family and talk with them before taking him to the OR; he was in no condition for any component of informed consent.
The family arrived 30 minutes later. His wife, the daughters who had been helping to take care of him, and two more relatives that had just arrived in town. His wife was clear: The man was sleeping all the time, losing weight, barely eating a couple of bites, unsteady on his feet, and confused when he was awake. I discussed options: The surgeon part of me wanted to “fix the hole,” the ICU doc in me knew he would die in the ICU on a ventilator, and the palliative medicine part of me knew hospice was his best option. I told the family he needed surgery but would likely not leave the hospital alive. I recommended hospice.
The wife was thoughtful and looked at her daughters and said, “We need to send him to hospice.” The wife and daughters were the easiest family I have spoken with in a long time. She was clear about whet he wanted and how much he had declined in the past few months. We were able to get him to inpatient hospice from the ED.
Surgery has changed, at least in my practice. Oh, what would I give for a healthy 17-year-old with appendicitis who gets better within hours of the operating room and my conversation with the family that takes 10 seconds. Instead, I take care of the very old and the very sick and the very chronically ill. My conversations are not “you need surgery;” that is done by the chief resident. My conversations are “tell me your functional status and what do you want if/when things go poorly.” Much more complicated and much less fun. The surgeon wants to fix the hole. I can fix the hole. But have I really helped the patient and his or her family? Although it takes me longer and involves more of my emotions and skills, it really is better for the patients and their families to have “the talk.”
Next time you see a patient who is chronically ill, please have the conversation about functional status and goals of care, before you operate. Or transfer. Perhaps then we can save the patient a helicopter ride to hospice.
Dr. Toevs is a trauma critical care surgeon at Allegheny General Hospital in Pittsburgh. She has a master’s degree in bioethics and board certification in hospice and palliative medicine.
The surgery chief resident texted me: “Patient in ED with peritonitis. Incarcerated hernia.”
I came to the ED; should be easy I thought. See the patient, have a short conversation since the chief resident would have done all the preop. Of course, things are rarely that simple.
First, she was a Jehovah’s Witness on warfarin with an INR of 4. More significantly, she had end-stage COPD. I reviewed her CT scan and labs and went to see her and could tell without any conversation she needed an operation. I needed more information, but not about her belly pain or when it started or whether she had peritonitis on exam. I needed to know how far she could walk, how much oxygen was she on at home, how much was she sleeping, how much weight had she lost, and could she leave the house.
It took 30 minutes to determine her functional status, whether she would survive the postoperative ICU care, whether she would come off the ventilator, and would she want a tracheostomy. It took another 15 minutes to discuss blood product use. Her husband was present, and I left them to decide what they wanted within the context of her goals for her life. She accepted some blood products, underwent surgery, and did well. She came off the ventilator quickly postop and returned home from the hospital. Although she did well, we had a plan for the ventilator and her goals of care defined should she have done poorly.
He was 72, had stage IV lung cancer, and was too weak for chemotherapy. Now he had free air and peritonitis. The referring institution called me and said he was too much for their surgeons. I suggested perhaps they needed to have “the talk” prior to transport. They were unwilling to do so and sent him by helicopter because he was hypotensive. He clearly needed an operation by all surgical standards. But I wanted to wait for his family and talk with them before taking him to the OR; he was in no condition for any component of informed consent.
The family arrived 30 minutes later. His wife, the daughters who had been helping to take care of him, and two more relatives that had just arrived in town. His wife was clear: The man was sleeping all the time, losing weight, barely eating a couple of bites, unsteady on his feet, and confused when he was awake. I discussed options: The surgeon part of me wanted to “fix the hole,” the ICU doc in me knew he would die in the ICU on a ventilator, and the palliative medicine part of me knew hospice was his best option. I told the family he needed surgery but would likely not leave the hospital alive. I recommended hospice.
The wife was thoughtful and looked at her daughters and said, “We need to send him to hospice.” The wife and daughters were the easiest family I have spoken with in a long time. She was clear about whet he wanted and how much he had declined in the past few months. We were able to get him to inpatient hospice from the ED.
Surgery has changed, at least in my practice. Oh, what would I give for a healthy 17-year-old with appendicitis who gets better within hours of the operating room and my conversation with the family that takes 10 seconds. Instead, I take care of the very old and the very sick and the very chronically ill. My conversations are not “you need surgery;” that is done by the chief resident. My conversations are “tell me your functional status and what do you want if/when things go poorly.” Much more complicated and much less fun. The surgeon wants to fix the hole. I can fix the hole. But have I really helped the patient and his or her family? Although it takes me longer and involves more of my emotions and skills, it really is better for the patients and their families to have “the talk.”
Next time you see a patient who is chronically ill, please have the conversation about functional status and goals of care, before you operate. Or transfer. Perhaps then we can save the patient a helicopter ride to hospice.
Dr. Toevs is a trauma critical care surgeon at Allegheny General Hospital in Pittsburgh. She has a master’s degree in bioethics and board certification in hospice and palliative medicine.
ACS launches campaign to increase young surgeon membership
The American College of Surgeons (ACS) Division of Member Services is launching an initiative aimed at attracting more young surgeons to join the College. The campaign, “Realize the Potential of Your Profession,” will communicate the benefits of ACS membership, making an appeal in new and engaging ways to the next generation of surgeons and attempting to create a “buzz” about the benefits of ACS membership. Starting in January, the campaign will share videos with prospective young members and offer firsthand accounts from the best and the brightest young surgeons who have joined the College. The College will also host networking events in cities around the country, giving young surgeons opportunities to engage with their peers and other more senior College leaders. In addition, the College will explore ways to promote the message at local state chapter meetings and other conferences throughout the year.
“In recent years, we have seen a decline in young surgeons involved with ACS, and we really want to turn that around,” said Patricia L. Turner, MD, FACS, Director, Member Services. “There are so many ways the College supports surgeons in their careers, and in turn, young surgeons are critical to the future of our organization and our profession.”
The College is strong because of its membership. The ultimate goal of this initiative is to increase the levels of membership among young surgeons and enhance already robust ACS programs and benefits.
“Just as the Inspiring Quality initiative became a cornerstone mission of the College to advance surgical quality around the country, we can build on those efforts by helping young surgeons realize the potential of their profession through the College,” said David B. Hoyt, MD, FACS, ACS Executive Director. “The ACS has a legacy of excellence, and adding more young surgeons to our ranks and giving them access to a network of leaders and the array of resources that the College is known for will undoubtedly foster a future of excellence in surgical care.”
For more information on the campaign, visit the ACS website at https://www.facs.org/member-services/realize.
The American College of Surgeons (ACS) Division of Member Services is launching an initiative aimed at attracting more young surgeons to join the College. The campaign, “Realize the Potential of Your Profession,” will communicate the benefits of ACS membership, making an appeal in new and engaging ways to the next generation of surgeons and attempting to create a “buzz” about the benefits of ACS membership. Starting in January, the campaign will share videos with prospective young members and offer firsthand accounts from the best and the brightest young surgeons who have joined the College. The College will also host networking events in cities around the country, giving young surgeons opportunities to engage with their peers and other more senior College leaders. In addition, the College will explore ways to promote the message at local state chapter meetings and other conferences throughout the year.
“In recent years, we have seen a decline in young surgeons involved with ACS, and we really want to turn that around,” said Patricia L. Turner, MD, FACS, Director, Member Services. “There are so many ways the College supports surgeons in their careers, and in turn, young surgeons are critical to the future of our organization and our profession.”
The College is strong because of its membership. The ultimate goal of this initiative is to increase the levels of membership among young surgeons and enhance already robust ACS programs and benefits.
“Just as the Inspiring Quality initiative became a cornerstone mission of the College to advance surgical quality around the country, we can build on those efforts by helping young surgeons realize the potential of their profession through the College,” said David B. Hoyt, MD, FACS, ACS Executive Director. “The ACS has a legacy of excellence, and adding more young surgeons to our ranks and giving them access to a network of leaders and the array of resources that the College is known for will undoubtedly foster a future of excellence in surgical care.”
For more information on the campaign, visit the ACS website at https://www.facs.org/member-services/realize.
The American College of Surgeons (ACS) Division of Member Services is launching an initiative aimed at attracting more young surgeons to join the College. The campaign, “Realize the Potential of Your Profession,” will communicate the benefits of ACS membership, making an appeal in new and engaging ways to the next generation of surgeons and attempting to create a “buzz” about the benefits of ACS membership. Starting in January, the campaign will share videos with prospective young members and offer firsthand accounts from the best and the brightest young surgeons who have joined the College. The College will also host networking events in cities around the country, giving young surgeons opportunities to engage with their peers and other more senior College leaders. In addition, the College will explore ways to promote the message at local state chapter meetings and other conferences throughout the year.
“In recent years, we have seen a decline in young surgeons involved with ACS, and we really want to turn that around,” said Patricia L. Turner, MD, FACS, Director, Member Services. “There are so many ways the College supports surgeons in their careers, and in turn, young surgeons are critical to the future of our organization and our profession.”
The College is strong because of its membership. The ultimate goal of this initiative is to increase the levels of membership among young surgeons and enhance already robust ACS programs and benefits.
“Just as the Inspiring Quality initiative became a cornerstone mission of the College to advance surgical quality around the country, we can build on those efforts by helping young surgeons realize the potential of their profession through the College,” said David B. Hoyt, MD, FACS, ACS Executive Director. “The ACS has a legacy of excellence, and adding more young surgeons to our ranks and giving them access to a network of leaders and the array of resources that the College is known for will undoubtedly foster a future of excellence in surgical care.”
For more information on the campaign, visit the ACS website at https://www.facs.org/member-services/realize.
Laparoscopic distal gastrectomy gains clout
SAN FRANCISCO – Patients with early gastric cancer have less postoperative morbidity if they undergo laparoscopic instead of open distal gastrectomy, according to safety results of a phase III trial presented at the at the annual Gastrointestinal Cancers Symposium sponsored by the American Society of Clinical Oncology.
The trial – the first in a series by the Korean Laparo-endoscopic Gastrointestinal Surgery Study Group (KLASS-01) – was conducted among 1,416 patients with clinical stage I disease in Korea, where the proportion of esophagogastric cancers caught in early stages has increased with the introduction of a national screening program. The patients were randomized evenly to laparoscopic or open surgery.
Main results showed mortality was similarly low for the open and laparoscopic approaches. But the laparoscopic group had half the rate of wound complications and, in multivariate analysis, a 41% lower risk of postoperative morbidity.
“Laparoscopy-assisted distal gastrectomy for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complications compared with conventional open surgery,” concluded first author Dr. Hyuk-Joon Lee, a gastrointestinal surgeon at the Seoul National University Hospital, Korea.
Invited discussant Dr. Michael Kent of Harvard Medical School, director of minimally invasive thoracic surgery at Beth Israel Deaconess Medical Center, Boston, said, “It is clear that the KLASS study is the largest by far to evaluate laparoscopic gastrectomy.”
A similar trial in the setting of early colorectal cancer (N. Engl. J. Med. 2004;350:2050-9) led to rapid uptake of laparoscopic resection for those patients at high-volume centers, he noted. “Although we still await survival data from the KLASS study, I anticipate that laparoscopic gastrectomy will likewise become the preferred approach in high-volume centers, especially in countries such as Korea with a national screening program.
“However, I do not think that open gastrectomy is an operation of the past,” he added. “For one, the benefits have not been shown yet in advanced gastric cancer. Also, in low-volume centers, the expertise in laparoscopic surgery may not be sufficient to warrant this approach. I should also add that body habitus may render this operation more difficult in obese patients.”
Dr. Kent pointed out that patients with T1a disease have yet another option, endoscopic resection, which has been found to yield good results at least in a single-center retrospective study (Surg. Endosc. 2013;27:4250-8). “In regards to future clinical trials, I believe it would be important to determine which patients require surgical as opposed to an endoscopic resection,” he concluded.
A previously reported interim analysis of the KLASS-01 trial showed no significant difference in morbidity and mortality between the laparoscopic and open groups, allowing the trial to continue (Ann. Surg. 2010;251:417-20).
Eighty percent of patients on the trial had T1 disease. Within this subset, about 60% had T1a and 40% had T1b disease, Dr. Lee said.
In modified intention-to-treat analyses, patients in the laparoscopic group had a longer operation time (185 vs. 146 minutes) and fewer lymph nodes retrieved (41 vs. 43). But they had a lower estimated blood loss (119 vs. 194 mL) and shorter hospital stay (7.2 vs. 8.0 days).
The rate of surgical mortality was less than 1% and the rate of reoperation was about 1%, with no significant differences between groups.
Patients in the laparoscopic group had lower 30-day rates of postoperative morbidity (13.7% vs. 18.9%, P = .009), and the benefit of the less invasive approach remained significant after multivariate adjustment (odds ratio, 0.59; P = .001). Wound complications were half as common with laparoscopy (3.6% vs. 7.0%, P = .005).
Data on 5-year overall survival, the primary endpoint of the KLASS-01 trial, are expected later this year.
Dr. Kent asked, “In your country, for those patients with clinical T1a disease, how is a decision made regarding therapy?”
“I think if we can accurately diagnose the T stage as well as the N stage, we can surely adapt the endoscopic treatment for all the T1a cancer patients,” Dr. Lee replied. Such diagnosis has proved challenging, he added. Endoscopic resection is usually reserved for patients with tumors less than 2 cm in diameter showing differentiated histology and not invading the mucosa. “We have to move to the more accurate diagnosis of the TNM stage,” he concluded.
SAN FRANCISCO – Patients with early gastric cancer have less postoperative morbidity if they undergo laparoscopic instead of open distal gastrectomy, according to safety results of a phase III trial presented at the at the annual Gastrointestinal Cancers Symposium sponsored by the American Society of Clinical Oncology.
The trial – the first in a series by the Korean Laparo-endoscopic Gastrointestinal Surgery Study Group (KLASS-01) – was conducted among 1,416 patients with clinical stage I disease in Korea, where the proportion of esophagogastric cancers caught in early stages has increased with the introduction of a national screening program. The patients were randomized evenly to laparoscopic or open surgery.
Main results showed mortality was similarly low for the open and laparoscopic approaches. But the laparoscopic group had half the rate of wound complications and, in multivariate analysis, a 41% lower risk of postoperative morbidity.
“Laparoscopy-assisted distal gastrectomy for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complications compared with conventional open surgery,” concluded first author Dr. Hyuk-Joon Lee, a gastrointestinal surgeon at the Seoul National University Hospital, Korea.
Invited discussant Dr. Michael Kent of Harvard Medical School, director of minimally invasive thoracic surgery at Beth Israel Deaconess Medical Center, Boston, said, “It is clear that the KLASS study is the largest by far to evaluate laparoscopic gastrectomy.”
A similar trial in the setting of early colorectal cancer (N. Engl. J. Med. 2004;350:2050-9) led to rapid uptake of laparoscopic resection for those patients at high-volume centers, he noted. “Although we still await survival data from the KLASS study, I anticipate that laparoscopic gastrectomy will likewise become the preferred approach in high-volume centers, especially in countries such as Korea with a national screening program.
“However, I do not think that open gastrectomy is an operation of the past,” he added. “For one, the benefits have not been shown yet in advanced gastric cancer. Also, in low-volume centers, the expertise in laparoscopic surgery may not be sufficient to warrant this approach. I should also add that body habitus may render this operation more difficult in obese patients.”
Dr. Kent pointed out that patients with T1a disease have yet another option, endoscopic resection, which has been found to yield good results at least in a single-center retrospective study (Surg. Endosc. 2013;27:4250-8). “In regards to future clinical trials, I believe it would be important to determine which patients require surgical as opposed to an endoscopic resection,” he concluded.
A previously reported interim analysis of the KLASS-01 trial showed no significant difference in morbidity and mortality between the laparoscopic and open groups, allowing the trial to continue (Ann. Surg. 2010;251:417-20).
Eighty percent of patients on the trial had T1 disease. Within this subset, about 60% had T1a and 40% had T1b disease, Dr. Lee said.
In modified intention-to-treat analyses, patients in the laparoscopic group had a longer operation time (185 vs. 146 minutes) and fewer lymph nodes retrieved (41 vs. 43). But they had a lower estimated blood loss (119 vs. 194 mL) and shorter hospital stay (7.2 vs. 8.0 days).
The rate of surgical mortality was less than 1% and the rate of reoperation was about 1%, with no significant differences between groups.
Patients in the laparoscopic group had lower 30-day rates of postoperative morbidity (13.7% vs. 18.9%, P = .009), and the benefit of the less invasive approach remained significant after multivariate adjustment (odds ratio, 0.59; P = .001). Wound complications were half as common with laparoscopy (3.6% vs. 7.0%, P = .005).
Data on 5-year overall survival, the primary endpoint of the KLASS-01 trial, are expected later this year.
Dr. Kent asked, “In your country, for those patients with clinical T1a disease, how is a decision made regarding therapy?”
“I think if we can accurately diagnose the T stage as well as the N stage, we can surely adapt the endoscopic treatment for all the T1a cancer patients,” Dr. Lee replied. Such diagnosis has proved challenging, he added. Endoscopic resection is usually reserved for patients with tumors less than 2 cm in diameter showing differentiated histology and not invading the mucosa. “We have to move to the more accurate diagnosis of the TNM stage,” he concluded.
SAN FRANCISCO – Patients with early gastric cancer have less postoperative morbidity if they undergo laparoscopic instead of open distal gastrectomy, according to safety results of a phase III trial presented at the at the annual Gastrointestinal Cancers Symposium sponsored by the American Society of Clinical Oncology.
The trial – the first in a series by the Korean Laparo-endoscopic Gastrointestinal Surgery Study Group (KLASS-01) – was conducted among 1,416 patients with clinical stage I disease in Korea, where the proportion of esophagogastric cancers caught in early stages has increased with the introduction of a national screening program. The patients were randomized evenly to laparoscopic or open surgery.
Main results showed mortality was similarly low for the open and laparoscopic approaches. But the laparoscopic group had half the rate of wound complications and, in multivariate analysis, a 41% lower risk of postoperative morbidity.
“Laparoscopy-assisted distal gastrectomy for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complications compared with conventional open surgery,” concluded first author Dr. Hyuk-Joon Lee, a gastrointestinal surgeon at the Seoul National University Hospital, Korea.
Invited discussant Dr. Michael Kent of Harvard Medical School, director of minimally invasive thoracic surgery at Beth Israel Deaconess Medical Center, Boston, said, “It is clear that the KLASS study is the largest by far to evaluate laparoscopic gastrectomy.”
A similar trial in the setting of early colorectal cancer (N. Engl. J. Med. 2004;350:2050-9) led to rapid uptake of laparoscopic resection for those patients at high-volume centers, he noted. “Although we still await survival data from the KLASS study, I anticipate that laparoscopic gastrectomy will likewise become the preferred approach in high-volume centers, especially in countries such as Korea with a national screening program.
“However, I do not think that open gastrectomy is an operation of the past,” he added. “For one, the benefits have not been shown yet in advanced gastric cancer. Also, in low-volume centers, the expertise in laparoscopic surgery may not be sufficient to warrant this approach. I should also add that body habitus may render this operation more difficult in obese patients.”
Dr. Kent pointed out that patients with T1a disease have yet another option, endoscopic resection, which has been found to yield good results at least in a single-center retrospective study (Surg. Endosc. 2013;27:4250-8). “In regards to future clinical trials, I believe it would be important to determine which patients require surgical as opposed to an endoscopic resection,” he concluded.
A previously reported interim analysis of the KLASS-01 trial showed no significant difference in morbidity and mortality between the laparoscopic and open groups, allowing the trial to continue (Ann. Surg. 2010;251:417-20).
Eighty percent of patients on the trial had T1 disease. Within this subset, about 60% had T1a and 40% had T1b disease, Dr. Lee said.
In modified intention-to-treat analyses, patients in the laparoscopic group had a longer operation time (185 vs. 146 minutes) and fewer lymph nodes retrieved (41 vs. 43). But they had a lower estimated blood loss (119 vs. 194 mL) and shorter hospital stay (7.2 vs. 8.0 days).
The rate of surgical mortality was less than 1% and the rate of reoperation was about 1%, with no significant differences between groups.
Patients in the laparoscopic group had lower 30-day rates of postoperative morbidity (13.7% vs. 18.9%, P = .009), and the benefit of the less invasive approach remained significant after multivariate adjustment (odds ratio, 0.59; P = .001). Wound complications were half as common with laparoscopy (3.6% vs. 7.0%, P = .005).
Data on 5-year overall survival, the primary endpoint of the KLASS-01 trial, are expected later this year.
Dr. Kent asked, “In your country, for those patients with clinical T1a disease, how is a decision made regarding therapy?”
“I think if we can accurately diagnose the T stage as well as the N stage, we can surely adapt the endoscopic treatment for all the T1a cancer patients,” Dr. Lee replied. Such diagnosis has proved challenging, he added. Endoscopic resection is usually reserved for patients with tumors less than 2 cm in diameter showing differentiated histology and not invading the mucosa. “We have to move to the more accurate diagnosis of the TNM stage,” he concluded.
AT THE GASTROINTESTINAL CANCERS SYMPOSIUM
Key clinical point: Laparoscopic distal gastrectomy has less morbidity than does open distal gastrectomy.
Major finding: Patients in the laparoscopic group had a 41% lower adjusted risk of 30-day postoperative morbidity.
Data source: A randomized phase III trial of 1,416 patients with clinical stage I gastric cancer.
Disclosures: Dr. Lee disclosed that he had no conflicts of interest.
