General Surgical Oncology
Rotation Specific Goals & Objectives: Sunnybrook – HPB – AHPBA track
Medical Expert:
By the end of the rotation the General Surgical Oncology resident will be able to:
1.0 Medical History and Physical Examination
1.1 Effectively perform a liver, biliary or pancreas specific patient assessment and
consultation, including specific history and physical examination
1.2 Identify risk factors for liver, biliary, or pancreas cancers, including liver disease
(alcohol, prior transfusions, hepatitis, hemochromatosis, or prolonged
chemotherapy), familial history and genetic factors.
1.3 Identify prognostic factors for liver, biliary, or pancreas cancers, including
characteristics of prior cancers (i.e. primary cancer for liver metastases).
2.0 Diagnostic Test Knowledge
2.1 Demonstrate an understanding of the techniques and principles of liver, biliary and
pancreatic CT scan imaging evaluation, including evaluation of resectability for liver
lesions, future liver remnant volumetrics, and the SSO/AHPBA classification for
pancreatic cancer resectability.
2.2 Order MRIs in appropriate cases for liver, biliary, and pancreatic malignant and
benign disease.
2.3 Order PET in appropriate cases for the management of benign and malignant
biliary and pancreatic disease.
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2.4 Order endoscopic ultrasound in appropriate cases for the management of benign
and malignant biliary and pancreatic disease.
2.5 Discuss the complexities, advantages and disadvantages of biopsy for liver, biliary,
and pancreatic disease.
3.0 Clinical Diagnosis and Decision Making (analyzes and integrates relevant data)
3.1 Explain and evaluate the benign and malignant pathological aspects of liver, biliary,
and pancreas disease.
3.2 Demonstrate an understanding of the pathological marking and assessment of liver,
biliary, and pancreas specimens, including evaluation of margins, immunohistochemical stains, cytology, tumor markers, and other indicators of prognosis
and their relevance to treatment.
3.3 Stage liver, biliary, and pancreatic cancers clinically and pathologically.
3.4 Analyze and integrate relevant pathological, imaging and clinical data to formulate
diagnoses and select therapeutic strategies (feasibility/resectability, extent, and
timing of resection, sequencing of systemic and surgical therapies, surgical
approach laparoscopic or open), whether operative or non-operative, including
referrals to multidisciplinary cancer conference, medical and radiation oncologists,
interventional radiology (ablation, TACE), gastroenterologists, genetics, dieticians,
and psychology when appropriate.
3.5 Assess the indications and contraindications for pre-operative and post-operative
systemic chemotherapy and biologic therapies, and their sequencing with surgical
management.
3.6 Assess the indications and contraindications of hepatectomy for colorectal liver
metastases, hepatectomy and transplantation for primary liver cancer, hepatectomy
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for non-colorectal liver metastases, pancreaticoduodnectomy for peri-ampullary
cancer, distal pancreatectomy for pancreas cancer, extended cholecystectomy for
gallbladder cancer, management of colorectal liver metastases recurrence,
management of peri-ampullary cancer recurrence, radiation therapy for pancreatic
cancer, cholangiocarcinoma, and gallbladder cancer.
3.7 Demonstrate an understanding of the role of, and technical procedures for, liver
directed therapies – radiofrequency or microwave ablation, stereotactic radiation
therapy, and chemo or bland embolization.
4.0 Demonstrate proficiency in pre-operative and post operative patient management
4.1 Evaluate and assess patients for suitability for an operative procedure
4.2 Plan the surgical intervention and take into consideration specific anatomic
considerations via review of the imaging.
4.3 Evaluate and manage post op management issues, including wound healing,
anastomotic leak, liver insufficiency, bleeding, pain and psychosocial issues
4.4 Develop appropriate discharge and disposition plans for patients by assessing the
patients’ access to out-patient services, resources, and by working cooperatively
with the discharge planning service to obtain needed treatments and follow-up for
patients.
5.0 Recognize urgent situations and intervene quickly and effectively
5.1 Recognize and treat intra-operative and post-operative bleeding
5.2 Demonstrate the ability to cope with operating room environment stress and
respond appropriately to acute events.
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6.0 Technical and Procedural Skills Proficiency
6.1 Assess the indications and contraindications for, and demonstrate proficiency in the
performance of, common surgical procedures, including distal pancreatectomy,
pancreaticoduodenectomy, major liver resection, cholecystectomy, biliary resection
and reconstruction, and portal dissection.
6.2 Demonstrate proficiency in performing techniques and appropriate intra-operative
decision-making to minimize complications and achieve the best oncologic outcome
for cancer operations for liver, biliary, and pancreas procedures, including but not
limited to distal pancreatectomy, pancreaticoduodenectomy, major liver resection,
cholecystectomy, biliary resection and reconstruction, and portal dissection.
6.3 Demonstrate knowledge of appropriate incision, approach and exposure, as well as
relevant anatomy and tissue planes for liver, biliary, and pancreas procedures.
6.4 Demonstrate the ability to anticipate steps and critical points of the liver, biliary, and
pancreas procedures.
6.5 Demonstrate an understanding of intra-hepatic anatomy and lesions assessment
with intra-operative ultrasound.
6.6 Demonstrate the ability to manage a potentially catastrophic situation, including
effective response to massive bleeding.
6.7 Demonstrate the ability to cope with operating room environment stress.
6.8 Demonstrate an awareness of their limitations.
6.9 Demonstrate an understanding of the functioning of surgical tools and devices,
including but not limited to intra-operative ultrasound, sealing devices, staplers,
argon beam coagulator, intra-operative ablation devices.
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Communicator:
By the end of the rotation the General Surgical Oncology resident will be able to:
1.1 Demonstrate effective communication with patients and family to create and sustain a
professional therapeutic relationship taking into account the patients special
psychological, social, and cultural needs.
1.2 Provide clear and thorough explanation of diagnosis, investigation and management in
a professional manner and obtain informed consent, providing appropriate therapeutic
risk/benefit information for surgical patients and their families
1.3 Deliver “bad news” in a compassionate and sensitive manner.
1.4 Create written documentation that is timely, concise and accurate.
Collaborator:
By the end of the rotation the General Surgical Oncology resident will be able to:
1.1 Communicate effectively (timely, concisely and accurately) with physicians
(medical oncology, radiation oncology, family physicians, referring doctors etc.)
in written and oral forms and other health care providers (nurses, genetics)
1.2 Consult and collaborate effectively with other physicians and a multidisciplinary
team of expert health care professionals to provide optimal patient care,
education and research.
1.3 Demonstrate the ability to lead multidisciplinary discussions (multidisciplinary
cancer conferences, and individual discussions), including sequencing of various
therapeutic modalities, and to coordinate the multimodal therapy plan with other
physicians (surgeons, medical and radiation oncologists, interventional
radiologists).
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1.4 Collaborate effectively with other physicians for intra-operative planning (intraoperative ultrasound assessment and anatomic marking with radiology).
1.5 Demonstrate effective and respectful leadership in the operating room.
1.6 Contribute effectively to other interdisciplinary team activities, including patient
review working rounds.
1.7Recognizes and understands the roles and expertise of other health
professionals.
Manager:
By the end of the rotation the General Surgical Oncology resident will be able to:
1.1
Utilize resources effectively to balance patient care, learning needs, and outside
activities
1.2
Allocate finite health care resources wisely.
Health Advocate:
By the end of the rotation the General Surgical Oncology resident will be able to:
1.1 Demonstrate the ability to advocate for quality patient care.
1.2 Demonstrate knowledge of relevant risk and prognostic factors, and consider them in
decision-making and patient’s referral.
1.3 Recognize changing needs for social support systems for patients and their families
throughout diagnosis, treatment, transition to surveillance, and relapse.
1.4 Identify and refer patients to advocacy and supportive organizations
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Scholar :
By the end of the rotation the General Surgical Oncology resident will be able to:
1.1 Critically appraise and incorporate relevant current literature on the surgical
management of liver, biliary, and pancreatic cancer, in order to recognizes and make
use of evidence-based practices.
1.2 Demonstrate the ability to honestly evaluate their care of patients and engage in active
continued learning activities, via the development, implementation and monitoring of a
personal continued learning strategy.
1.3 Demonstrate knowledge in the conduct of surgical clinical trials, including screening for
eligible patients, recognition of adverse events, and understanding of protocol
compliance, and discuss the contribution of clinical trials to clinical practice.
1.4 Facilitate and participate in the education of patients, families, students, colleagues,
and other health care professionals in formal and informal settings.
1.5 Demonstrate understanding and contribution to the development of new knowledge via
participation in clinical, translational, or basic science research, including clear and
concise presentation of research findings.
Professional:
By the end of the rotation the General Surgical Oncology resident will be able to:
1.1 Demonstrate a commitment to excellence to patients, families and their profession in
clinical care and personal ethical conduct.
1.2 Demonstrate accountability to patients and healthcare professional colleagues.
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