Oncologic and Endocrine Surgery
Medical Student/Resident Handbook
Table of contents
Division of oncologic and endocrine surgery attendings
Division schedule for conferences/clinics/OR
General orientation for all residents and students
Breast surgery service orientation
Endocrine surgery service orientation
GI surgical oncology service orientation
Goals
- Exposed residents and students to the multidisciplinary care of surgical oncology patients as well as
management of breast and endocrine diseases.
Please refer to the goals provided by the residency program for each specific rotation (GI surgical
oncology, breast/endocrine rotation)
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Division of Surgical Oncology Attendings
Breast Disease / Cancer Surgery
Megan Baker Ruppel, MD, FACS
Associate Professor of Surgery
Medical Director Comprehensive Breast Care Hollings Cancer Center
Administrative Assistant: Katie Gracar
876-0179
David J. Cole, MD, FACS
Professor of Surgery
McKoy Rose Professor and Chairman of Surgery
Administrative Assistant: Dawn Hartsell
792-6194
Nancy De More, MD, FACS
Administrative Assistant: Katie Gracar
876- 0179
Rochelle Ringer, MD , FACS
Administrative Assistant: Katie Gracar
876- 0179
Mark A. Lockett, MD, FACS
Associate Professor
Vice Chair of Veteran Affairs
Administrative Assistant: Beth Welch
876-0781
Endocrine Surgery
Denise Carneiro-Pla, MD, FACS
Associate Professor of Surgery
Administrative assistant: Beth Welch
876-0181
Melanoma / Sarcoma / Gastrointestinal / Hepatopancreatobiliary / Colorectal Surgery
E. Ramsay Camp, MD, FACS
Assistant Professor of Surgery
Administrative Assistant: Stacy Miers
876-4420
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David J. Cole, MD, FACS
Professor of Surgery
McKoy Rose Professor and Chairman of Surgery
Administrative assistant: Dawn Hartsell
792-6194
Eric Kimchi, MD, FACS
Associate Professor of Surgery
Administrative Assistant: Stacy Miers
876-0179
Kevin Staveley-O’Carroll, MD, PhD, FACS
Alice Ruth Reeves Folk Endowed Chair of Clinical Oncology
Professor and Chief, Oncologic & Endocrine Surgery
Medical Director of the Hollings Cancer Center
Administrative Assistant: Stacy Miers
876-4420
Division of Surgical Oncology Midlevel Support
Denise Bradshaw, MSN, FNP-C
Clinical Instructor
Dr. Carneiro-Pla
Laurrie Rumpp, RN, MSN/FNP
Clinical Instructor
Dr. Camp, Dr. Kimchi, Dr. Staveley-O’Carroll
Brenda Toohey, MSN, APRN-BC, CBCN
Clinical Instructor
Dr. Baker, Dr. Lockett, Dr. DeMore, Dr. Ringer
Jacqueline Eckert, PA-C
Clinical Instructor
Dr. Cole
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OR and Clinic schedules:
Monday
Clinic
OR
Tuesday
Clinic
OR
Wednesday
Clinic
Thursday
Tumor
Board
OR
Clinic
OR
Friday
Tumor
Board
Clinic
OR
CarneiroPla
NC
specialty
care
DeMore
AM
CarneiroPla
CarneiroPla
Kimchi
HCC 2nd
floor
8:30am4pm
StaveleyO’Carroll
nd
HCC 2
floor
8am-3pm
Camp
Breast
HCC 120
8AM
Baker
Camp
HCC
2nd
floor
9am1pm
GI
8am9am
Baker/
Cole/
DeMore
StaveleyO’Carroll
Sarcoma
weeks 2&4
HCC 120
7am
Cole
Lockett
Melanoma
CarneiroPla
weeks 1&3
HCC 120
7am
CarneiroPla
PM
CarneiroPla
HCC 2nd
floor
8:30am4pm
Baker
Kimchi
Camp
Kimchi
StaveleyO’Carroll
nd
HCC 2
floor
8am-3pm
HCC
2nd
floor
1pm5pm
Baker/
Cole/
DeMore/
Lockett
Cole
CarneiroPla
4
StaveleyO’Carroll
CarneiroPla
NC
specialty
care
DeMore
General guidelines for residents (for GI and Breast/ Endocrine
services):
Service: GI Surgical Oncology and Breast/Endocrine Surgery
Primary Hospital: Ashley River Tower (ART)/ Hollings Cancer Center (HCC)
Morning rounds start:
Time: per Chief Resident
Location: ART
Attending Rounds: Attending rounds are held at various times depending on the activities on the
service. The housestaff or attendings will make you aware when rounds are beginning.
Clinics and OR to attend: You will rotate the schedule below on a weekly basis.
Monday
GI OR (Kimchi)
Endo OR (Carneiro-Pla)
Tuesday
GI OR (Camp)/
Endo Clinic (Carneiro-Pla)
Breast OR (Lockett)
Wednesday GI/Breast OR (Cole/ Baker)
GI Clinic (Camp/Kimchi)
Thursday
Breast Clinic (Baker/
DeMore)
GI OR (Staveley-O’Carroll)
Friday
GI OR (Camp/Kimchi/KSOC) Breast OR (Baker)
Service specific conferences which should be attended by third and fourth year medical
students even on post call days. (Conferences in addition to the required department
conferences):
GI Tumor Board: Held on each Wednesday at 8am in conference room 120 on the first floor of
Hollings Cancer Center
Melanoma Tumor Board: Held the 1st and 3rd Thursday of the month at 7AM at Hollings Cancer
Center conference room 120
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Sarcoma Tumor Board: Held the 2nd and 4th Thursday of the month at 7AM at Hollings Cancer
Center conference room 120
Breast Tumor Board: Held on each Thursday 8am-9am Hollings Cancer Center 121
Surg Onc/Breast/Endocrine Teaching Sessions: These sessions will be held different days of the
week by Oncologic and Endocrine Surgery division faculty. The calendar is available at the surgical
oncology website. Each attending will determine the format of their teaching sessions. These
sessions are mandatory for all students and residents.
Operating room: We like to have students scrub in on as many of our cases as possible. We also,
though, encourage you to see cases on other services when our service is “quiet” or when there is a
case you need to see to fulfill a requirement for the course or when you find a case that interests you.
Please make sure that the senior resident on the service know you are scrubbing on a case on
another service. Also, let the resident know when that case has finished.
Patient Care: We expect you to follow 2 to 3 patients at the most on the floor. For those patients, we
expect you to write a complete progress note daily. We also want you to present the case on rounds
with the housestaff and to the attending on attending rounds. Follow those patients to the operating
room and take responsibility for assuring that all labs, X rays, and other tests are completed and that
you have read all the reports on this testing. Make sure that the attendings and housestaff are aware
of any significant results or findings on your patients.
•
Residents:
GI surgical oncology:
PGY-5 and 2 PGY-1
Director of the rotation: Dr. Carneiro-Pla
Breasts/ endocrine surgery:
PGY-2.
Director of the rotation: Dr. Carneiro-Pla
•
Students: Usually two 3rd year medical students and occasionally a 4th year medical student.
Director of the rotation: Dr. Camp
Routine of the services
1. All in patient rounding and notes should be completed prior to 7:15 am. Residents are expected
to be in the OR room by 7:15 am each OR day. Residents are expected to contact the appropriate
attending to run the patient list prior to starting the first OR case of the day or clinic schedule.
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2. Residents are expected to contact the rotation director for any non-vacation time off requests from
the service as well as to notify that director in the event that they are ill and unable to come to
work. Residents are expected to notify affected attendings and team members regarding
upcoming scheduled vacation or out of town meetings so that appropriate case and clinic
coverage may be arranged.
3. Residents are expected to immediately notify the rotation director if they are unable to comply with
the work hours regulations as detailed by the ACGME and the Department of Surgery or are at
risk for a violation.
Rounds
The entire team( GI and Breast/Endo) should round in the morning on all patients at the time
determined by the PGY-5. Data should be presented in an organized way and thoroughly
reviewed by the team at the bedside each morning with the resident responsible for the patient
signing the note written by the medical student. Every patient should have a note in the chart
every morning signed by the resident. All patients should be examined each morning. It is the
expectation of the service that the PGY 5 chief resident assign specific OR cases (GI Surg Onc
and Breast/Endo) to the medical students for the following day so that they can prepare properly
the night before.
1. The PGY 5 and interns are responsible for writing notes, orders and discharge instructions on
patients from GI surgical oncology. GI surgical oncology consults should be addressed by the
interns and PGY 5. PGY 2 should see consults only when available and free from
Breast/endocrine duties.
2. The PGY 2 and interns are responsible for writing notes, discharge instructions and orders for the
breast/endocrine service. The breast/endocrine consults should be addressed by the PGY 2.
3. Students are responsible for writing notes on their patients in the morning and presenting the case
to the corresponding attending during rounds. Students are expected to know labs, complete
history, surgeries, vitals, I/O of their patients.
Although the PGY 2 is also part of the GI surgical oncology team, the breast/ endocrine
rotation have priority over any other activity. If the PGY 2 resident is not engaged by the demands
of Breast/Endo, they should join the GI Surg Onc team for activities such as clinic and OR.
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Any and all residents are expected to respond to any patient emergency in any of the
services.
Consults
There is a call schedule for surgical oncology which includes the GI surgical oncology
attendings as well as breast and endocrine attendings. Every consult needs to be seen within 2
hours from the initial call regardless if emergent or not. A consult should be filled in EPIC and
forward to the consulting surgeon at that time. The attending should be notified and the consult
should be discussed at that time with the surgeons on call. As a guide to the residents, if the
surgeon on call is not specialized on the area of the consult during weekdays and working hours,
the attending on call will call the next person on call specializing in the area of the consult - such
as GI surgical oncology consults to Dr. Staveley-O’Carroll, Dr. Camp, Dr. Kimchi; breast consults
to Dr. Baker, Dr. Lockett, Dr. DeMore and Dr. Cole; and endocrine consults to Dr. Carneiro-Pla. If
the next person on call on for that consult specialty is not in town, the attending on call will
continue on in the call schedule for the next person.
Surgical consults which require an immediate or urgent operation should be directed to the
attending on the call schedule for that day. If you have any question about who to contact,
always start with the attending listed on call for that day.
Operating Room Experience
GI surgical oncology: The Chief Resident and interns will cover the cases at the ART OR
Breast/Endocrine: The PGY 2 will cover the breast/endocrine service covering cases at the ART
OR. On Mondays the PGY 2 covers Dr. Carneiro-Pla’s cases and on the other days of the week,
the Breast cases. On Wed, Dr. Carneiro-Pla’s cases will be cover by a student or PGY 1.
Clinics: The clinics schedule is shown on the table above.
GI surgical oncology: Chief resident and the interns should attend clinics for Dr. Camp, Dr.
Staveley-O’Carroll, and Dr. Kimchi. The Chief resident is required to attend at least one of
these clinics a week.
Breast and Endocrine: PGY 2 should cover the clinics of Breast/Endocrine if not on the
operating room. The PGY2 is required to attend at least 2 Endocrine Surgery clinics (Dr.
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Carneiro-Pla) and 2 Breast surgery clinics during their rotation (Dr. Baker, Dr. DeMore, Dr.
Cole and Dr. Lockett).
When any of the residents are free from duties with Breast/Endocrine rotation, he/she
should attend the GI surgical oncology clinic
The students’ scheduled for clinics and OR can be found on the following link:
Pending
•
Teaching Conferences: (Coordinator: Dr. Carneiro-Pla)
1. GI/breast/endocrine:
a. Weekly teaching session. Attending instructor, time and location are available on the link:
PENDING. The attendance of these lectures is mandatory for all residents and students on
the Oncologic and Endocrine Surgery rotation. Each attending uses a different formats,
therefore ask your attending if a subject needs to be prepared for this lecture.
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Orientation specific for the Breast Surgery Rotation: PGY 2
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Meetings/Conferences:
1. PGY 2 Resident is expected to attend Multidisciplinary Breast Conference on Thursday from 7:308:30 in HCC 121.
2. Residents are expected to cover breast cases in OR and attend breast clinic when not in the OR
or teaching session (Cole, Baker, Lockett, DeMore).
3. Residents are expected to arrange a one day shadowing experience with Dr. Jennifer Harper in
radiation oncology. Resident should contact Dr. Harper via email and ask for her availability.
4. Resident should then notify Breast attendings of the Rad Onc shadowing day and they will be
excused from clinic duties for that experience.
5. Likewise, residents are expected to shadow the breast imaging team in Mammo 3rd Floor of
Hollings Cancer Center for a day and to notify attendings of their scheduled day. No prior
notification required by the Breast Imaging Team.
•
Operating Room Experience:
1. Residents are expected to be in OR by 7:15 am.
2. The resident is expected to read about the patient's history, preoperative workup, procedure to be
performed, and pathology in question. Residents are expected to have reviewed an operative
atlas as a means of preparation for operative technique.
3. Resident may be responsible for dictating the operative note – attending specific. Please clarify
with every case your responsibility for this task.
•
Floor Duties:
1. The resident will be asked the patient’s medical condition, overnight events, physical examination,
laboratory findings and plan of care.
2. The resident is expected to complete the medication reconciliation form, discharge orders, write
the necessary prescriptions and print the discharge instructions from the clinical forms placing it in
the chart at the end of the surgery.
https://www.musc.edu/cce/ORDFRMS/pdf/breastoutptdcorders.pdf
https://www.musc.edu/cce/ORDFRMS/pdf/mastectomydcorders.pdf
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3. Patients with 23 hour admission also need discharge summary.
4. For joint cases with plastics, residents will often need to coordinate care planning with the plastic
surgery team to ensure appropriate in patient physical therapy consultation placement, activity
restrictions, and follow up care plan. Patients undergoing tissue expander or implant
reconstruction are typically admitted to Surgical Oncology whereas patients undergoing flap
reconstruction are admitted to Plastic Surgery
5. Team is expected to perform afternoon patient rounds and to report any concerns or findings to
responsible attendings daily.
Inpatient Breast Care Management Pearls:
1. All patients who undergo mastectomy and or axillary lymph node dissection require an inpatient
physical therapy consultation.
2. All patients with drains require an order for drain teaching and drain log provision in nursing notes.
3. Breast patients’ diet may be advanced aggressively as tolerated to facilitate prompt
discontinuation of IV medications and IV fluids.
4. Patient who have undergone an axillary node dissection will need arm precautions (no IV sticks,
blood draws, or BP recordings in that arm; this is part of order set in CPOE.)
5. Mastectomy patients should have received a soft cotton mastectomy bra preoperatively. If they
have not, the Breast Cancer Nurse Navigator (Denise Kepecs or Jennifer Wood) should be
contacted via simon page to assist.
6. All in patients will need a referral for Reach for Recovery (part of CPOE order set). This facilitates
the paring of our patients with American Cancer Society resources.
7. Foley catheters when used are typically discontinued in the OR or shortly after arriving on the
floor.
•
Required Reading:
http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/presentatio
ns/mayo1.pdf
http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/presentatio
ns/mayo2.pdf
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Breast Rotation Pre and Post written test:
All PGY 2 and PGY 4 residents are expected to take the breast surgery post test on the last Thursday
of the 2 month rotation during the scheduled teaching session. This test is available to residents
below as a tool to help guide their reading during the rotation. The same test will be administered at
the close of the rotation. A minimum score of 75% is required to pass the test which is one of the
requirements for passing the rotation.
Breast Surgery Rotation Pre/Post Test
Name:
PGY:
1. What are common stimulants of breast pain and what is its work up for mastodynia?
2. What is the most common cause of bloody nipple discharge?
3. What is the diagnostic workup for blood nipple discharge?
4. What medications can be utilized to reduce risk for breast cancer?
5. What is the most appropriate imaging work-up for a palpable breast mass in a 40 yo female?
6. What is the most appropriate method to diagnose a breast mass suspicious for cancer?
7. What is the most common treatment recommendation for women with small <4cm unifocal
invasive breast cancers?
8. What does that therapy entail?
9. Is there an alternative to this therapy and if so what is it?
10. Which ancillary studies do you order once you have confirmed a breast cancer diagnosis?
11. Describe the tissues removed with a total or simple mastectomy?
12. Describe the tissues removed during a modified radical mastectomy?
13. Describe the tissues removed during a radical mastectomy?
14. Describe the tissues removed with a skin sparing mastectomy?
15. Describe the tissues removed with a nipple sparing mastectomy?
16. Which genetic mutations are associated with increased risk for breast cancer?
17. While taking a family history, which other cancers are important to inquire about to determine
risk of hereditary breast cancer?
18. Name an assessment tool that can be used to determine a woman’s risk for breast cancer?
12
19. What are the two classes of oral medication used to treat breast cancer and in what setting are
they used?
20. What are the three classes of intravenous chemotherapy commonly used in the treatment of
breast cancer that have been associated with improved overall survival?
21. Please list contraindications for breast conserving therapy?
22. Please list indications for post mastectomy radiation therapy?
23. True or False: it is safe to give breast cancer chemotherapy during pregnancy?
24. How do you determine if you have found all the sentinel lymph nodes?
25. What two medications can be used for sentinel lymph node injection and what is the most
concerning side effect of each?
26. What should you do if a palpable breast mass in a woman over 35 years of age has no
imaging correlate?
27. What is a concordance report and why is it important?
Orientation specific for Endocrine Surgery rotation: PGY 2
•
Weekly schedule
Monday: Full operating room day covered by PGY2
Tuesday: Rounds in the morning with Dr. Carneiro-Pla followed by full clinic day at Hollings cancer
center, third floor, Cooper Pavilion.
Wednesday: Full operating room day covered by Student or PGY1.
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Thursday: Endocrinology and metabolism grand rounds 8:00 on clinical science building on 8th floor
endocrinology department followed by rounds with Dr. Carneiro-Pla.
Friday: Full day clinic in North Charleston specialty care if no operating room coverage is needed.
PGY2 is required to attend at least 2 endocrine surgery clinics/month during the rotation.
•
Operating room experience:
1. On Mondays, the PGY2 resident is expected to be in the operating room no later than 7:15 AM to
position the patient after intubation, check endotracheal tube with bronchoscope, perform an
ultrasound with possible fine-needle aspiration guided by ultrasonography and marked the
patient's neck incision site.
2. The resident is expected to read about the patient's history, preoperative workup, procedure to be
performed, and pathology in question.
3. Ocasionally, the residents are asked to help with the dictation of the cases they perform. Example
of the most common procedures can be found on the following links:
Parathyroidectomy description
Total thyroidectomy description
Left laparoscopic adrenalectomy anterior approach
Right laparoscopic adrenalectomy anterior approach
Rounds
4. The resident will be asked patient medical condition, overnight events, physical examination,
laboratory findings and plan of care.
5. The resident is expected to call Dr. Carneiro-Pla 305-915-4469 if concerns.
6. Discharge summaries are now on EPIC. Please contact Dr. Carneiro-Pla if you don’t have the
smartphrase for Endorine Discharge Summaries. The Interns should complete the discharge
summary on the chart and request for cosign to Dr. Carneiro-Pla. Please do not request
cosignature for progress note. The PGY2 is responsible for the accuracy of these summaries by
communicating the intraoperative plan to the interns.
7. Dr. Carneiro-Pla will do the medication reconciliation and discharge instructions before talking to
the patients.
8. Standard approach for patients who underwent cervical exploration:
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a. Evaluate patient’s neck in the afternoon after the procedure and on postoperative day
one while the patient is sitting up.
b. All patients should have the cervical incision covered by an ice pack at all times with a
washcloth to protect the skin.
c. All patients should have incentive spirometry.
d. All patients should have SCDs.
e. All patients should have the head of the bed elevated at least 30°at all times.
f. Patient should be instructed NOT to laydown flat or on their sides.
g. Discussed with Dr. Carneiro-Pla before giving narcotics or IV calcium. PGY2 and
interns should make sure the night call team is aware of these guidelines.
h. Patients should NOT be placed on aspirin or anticoagulation without discussing with Dr.
Carneiro-Pla.
i.
Patients are usually seen in clinic the week after the procedure. Discussed with the
attending day of the follow-up appointment.
j.
The only medications requiring prescriptions upon discharge are Calcitriol (0.5 mcg po
qd usually, 30 days and NO REFILLS), Synthroid on the dose order on postoperative
orders) and ergocalciferol (50K U once a week for 6 weeks NO REFILLS).
k. Don’t give IV calcium and narcotics without discussing with Dr. Carneiro-Pla first
•
Required reading
1. ATA_MTC_Guidelines_2009 medullary
2. ATA_DTC_Guidelines_2009 thyroid nodule and thyroid cancer
3. thy.2009 central neck dissection
4. AdrenalGuidelines AAES
5. The National Institutes of Health (NIH) Consensus Development Program Diagnosis and
Management of Asymptomatic Primary
Hyperparathyroidism
6. Management of the Clinically Inapparent Adrenal Mass (Incidentaloma)
Endocrine Rotation Pre and Post written test:
All PGY 2 residents are expected to take the endocrine surgery post-test on the last week of the
second month rotation during the scheduled teaching session. This test is available to residents
15
below as a tool to help guide their reading during the rotation. A minimum score of 75% is required to
pass the test which is one of the requirements for passing the rotation.
Endocrine surgery post rotation test
Name: _____________________________________________________________________
Thyroid disease
1.
2.
3.
4.
5.
6.
7.
8.
9.
Give 3 risk factors for well differentiated thyroid cancers:
Name 7 malignant tumors which can be found within the thyroid gland:
Which is the most accurate diagnostic test in the evaluation of a thyroid nodule?
Which thyroid cancers can be diagnosed with a fine-needle aspiration?
Which operative procedure should be used to treat the following patients:
a. 60-year-old female with a 2 cm papillary cancer on the right lobe, no evidence of lymph
nodes or lesions on the opposite thyroid lobe.
b. 30-year-old female with medullary thyroid cancer measuring 3 cm on the left lobe with no
evidence of malignant lymphadenopathy on preoperative ultrasound on bilateral lateral
neck
c. 55-year-old male with a 3 cm follicular carcinoma found on postoperative pathology of her
right thyroid lobectomy.
d. 45-year-old female with a mass adjacent to the trachea measuring 3 cm following total
thyroidectomy and radioactive iodine treatment for papillary cancer. This patient has
detectable thyroglobulin and atypical cells on fine-needle aspiration of this lesion
e. 65-year-old female with a large anaplastic cancer causing airway obstruction
Which are the indications for thyroidectomy in patients with hyperthyroidism (name 4
indications)?
Which is the incidence of thyroid cancer in a thyroid nodule?
Which is incidence of false negative results during fine-needle aspiration?
Following total thyroidectomy for well differentiated thyroid cancer, which are the 2 most
important therapies for these patients?
Parathyroid disease
1. How the diagnosis of sporadic primary hyperparathyroidism is confirmed?
2. Which are the indications for parathyroidectomy in patients with sporadic primary
hyperparathyroidism?
3. Name 3 causes of secondary hyperparathyroidism in patients with end-stage renal disease:
16
4. Name 2 operative approaches used to treat sporadic primary hyperparathyroidism:
5. Which is the operative procedure of choice for patients with secondary hyperparathyroidism
and end stage renal disease?
6. Which is the operative procedure choice for patients with multiple endocrine neoplasia 1?
7. Describe all the areas that should be explored intraoperatively when a parathyroid gland is
missing:
8. Which are the tumors associated to multiple endocrine neoplasia 1?
9. Which are the tumors associated to multiple endocrine neoplasia 2A and 2B?
Adrenal disease
1. Which is the biochemical workup used to evaluate an incidentaloma?
2. Which are the biochemical and clinical differences between paragangliomas and
pheochromocytomas?
3. Which is the management of pheochromocytoma?
4. Which is the management of an adrenal adenoma?
5. Described the management of a 6 cm incidentaloma:
6. How the diagnosis of primary hyperaldosteronism is made?
7. Which is the management of a 60-year-old patient with primary hyperaldosteronism and a
right adrenal mass?
8. Which is the management of a 30 year-old female with primary aldosteronism and a 2 cm
mass on the right adrenal and a 0.5 cm mass on the left adrenal?
9. Describe the steps of a left laparoscopic adrenalectomy using the anterior approach:
10. Describe the steps of the right laparoscopic adrenalectomy using the anterior approach:
11. Describe indications for adrenalectomy for a non-functioning adrenal mass:
12. When an adrenal mass biopsy is indicated?
Orientation specific for GI Surgical Oncology : PGY 1-5
•
Tumor Boards:
GI Tumor Board: HCC 120 every Wednesday at 4PM
Melanoma Tumor Board: HCC 120 1st and 3rd Thursday 7AM.
17
Sarcoma Tumor Board: HCC 120 2nd and 4th Thursday 7AM.
Tumor Boards should be attended unless resident and students are in OR at that time.
Reading: Melanoma
Critical Topics:
1. Surgical margins-trials, AJCC staging, pathologic factors
2. Lymph node mapping
3. Lymph node dissection-techniques and complications
4. Limb perfusion-technique, results
5. Surgical treatment of metastatic disease
6. Ocular and anal melanoma
7. Adjuvant therapy results
8. Treatment of advanced/metastatic disease
9. Bioimmunotherapy
References:
1. Gimotty PA, et al. Identification of high-risk patients among those diagnosed with thin
cutaneous melanomas. J Clin Oncol 2007;25:1129-1134.
2. Balch CM, et al. Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm
excision margins for 740 patients with 1-4 mm melanomas. Ann Surg Oncol 2001; 8:101-108.
3. Thomas JM, et al. Excision margins in high-risk malignant melanoma. N Engl J Med
2004;350:757-766.
4. Morton DL, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med
2006;355:1307-1317.
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5. Wright BE, et al. Importance of sentinel lymph node biopsy in patients with thin melanoma.
Arch Surg 2008;143:892-899; discussion 899-900.
6. Eggermont AM, et al. Post-surgery adjuvant therapy with intermediate doses of interferon alfa
2b versus observation in patients with stage llb/lll melanoma (EORTC 18952): randomized
controlled trial. Lancet 2005;366:1189-1196.
7. Henderson MA, et al. Adjuvant radiotherapy and regional lymph node field control in
melanoma patients after lymphadenectomy: Results of an intergroup randomized trial
(ANZMRG 01.02/TROG 02.01) [abstract]. J Clin Oncol 2009;27 (Suppl 18):LBA9084.
8. Linder P, et al. Prognostic factors after isolated limb infusion with cytoxic agents for melanoma.
Ann Surg Oncol 2002;9:127-136.
Reading: Sarcoma
Critical Topics:
1. Pathology, classification, staging
2. Retroperitoneal sarcoma-surgical approach
3. Limb sarcomas
4. Advanced surgical techniques-forequarter, hemipelvectomy, limb-sparing
5. Limb perfusion trials
6. Chemotherapy for sarcoma
7. Radiation therapy for sarcoma
8. Surgery for metastatic disease
References:
1. Pisters PW, et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue
sarcomas of the extremities. J Clin Oncol 1996;14:1679-1689.
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2. Zagars GK, et al. Surgical margins and resection in the management of patients with soft
tissue sarcoma using conservative surgery and radiation therapy. Cancer 2003;97:2544-2553.
3. Pisters PW, et al. Long-term results of a prospective randomized trial of adjuvant
brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859-868.
4. Pisters PW, et al. Recommendations for Local Therapy for Soft Tissue Sarcomas. J Clin Oncol
2007;25:1003-1008.
5. Pisters PW, et al. Long-term results of prospective trial of surgery alone with selective use of
radiation for patients with T1 extremity and trunk soft tissue sarcomas. Ann Surg
2007;246:675-681.
6. Grobmyer SR, et al. Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue
sarcoma. Ann Oncol 2004;15:1667-1672.
7. Heslin MJ, et al. Prognostic factors associated with long-term survival for retroperitoneal
sarcoma: implications for management. J Clin Oncol 1997;15:2832-2839.
8. Bonvalot S, et al. Primary Retroperitoneal Sarcomas: A Mutivariate Analysis of Surgical
Factors Associated With Local Control. J Clin Oncol 2009;24:31-37.
9. Pawlik TM, et al. Long-term results of two prospective trials of preoperative external beam
radiatiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma.
Ann Surg Oncol 2006;13:508-517.
10. Raut CP, et al. Surgical Management of Advanced Gastrointestinal Stromal Tumors After
Treatment With Targeted Systemic Therapy Using Kinase Inhibitors. J Clin Oncol
2006;24:2325-2331.
11. Lev D, et al. Optimizing treatment of desmoids tumors. J Clin Oncol 2007;25:1785-1791.
Reading: Stomach
Critical Topics:
1. Diagnosis, pathology, staging of adenocarcinoma
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2. Surgical techniques and extent of lymphadenectomy
3. Results of neoadjuvant and adjuvant therapy trials/studies
4. Gastric lymphoma and carcinoid
5. GIST-surgical and medical management
References:
1. Chau I, et al. Multivariate prognostic factor analysis in locally advanced and metastatic
esophago-gastric cancer—pooled analysis from three multicenter, randomized, controlled trials
using individual patient data. J Clin Oncol 2004;22:2395-2403.
2. Karpeh MS, et al. Lymph node staging in gastric cancer: is location more important than
Number? An analysis of 1,038 patients. Ann Surg. 2000;232:362-371.
3. Bentrem D, et al. The value of peritoneal cytology as a preoperative predictor in patients with
gastric carcinoma undergoing a curative resection. Ann Surg Oncol 2005;12:347-353.
4. Bozzetti F, et al. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates
in a multicenter randomized Italian trial. Italian Gastrointestinal Study Group. Ann Surg
1999;230:170-178.
5. Sasako M, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric
cancer. N Engl J Med 2008;359:453-462.
6. Hartgrink HH et al. Extended lymph node dissection for gastric cancer: who may benefit? Final
results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22:2759-2761.
7. Huscher CGS, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer:
five year results of a randomized prospective trial. Ann Surg 2005;241:232-237.
8. Ajani JA, et al. Multi-institutional trial of preoperative chemoradiotherapy in patients with
potentially respectable gastric carcinoma. J Clin Oncol 2004;22:2774-2780.
9. Cunningham D, et al. Perioperative chemotherapy versus surgery alone for respectable
gastroesophogeal cancer. N Engl J Med 2006;355:11-20.
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10. Andtbacka RH, et al. Surgical resection of gastrointestinal stromal tumors after treatment with
imatinib. Ann Surg Oncol. 2007 Jan:14(1):14-24
Reading: Pancreas
Critical Topics:
1. Pancreaticoduodenectomy-advanced techniques
2. Surgical considerations for body tail tumors
3. Cystic neoplasms of the pancreas
4. Neoadjuvant and adjuvant therapy for respectable pancreatic adenocarcinoma
5. Treatment of locally advanced/metastatic pancreatic adenocarcinoma
6. Islet cell tumors
References:
1. Ferrone CR Perioperative CA19-9 can predict stage and survival in patients with respectable
pancreatic adenocarcinoma. J Clin Oncol 2006;24:2897-2902.
2. Raut CP, et al. Impact of resection status on pattern of failure and survival after
pancreaticoduodenectomy specimens including a checklist. Dig Surg 1999;16:291-296.
3. Yeo CJ, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative
adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann
Surg 1987;206:358-365.
4. Varadhachary GR, et al. Borderline respectable pancreatic cancer: definitions, management,
and role of properative therapy. Ann Surg Oncol 2006;13:1035-1046.
5. van der Gaag NA, et al. Properative biliary drainage for cancer of the head of the pancreas. N
Engl J Med 2010;362:129-137.
6. Tseng JF, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival
duration. J Gastrointest Surg 2004;8:935-949.
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7. Smeenk HG, et al. Long-term survival and metastatic pattern of pancreatic and periampullary
cancer after adjuvant chemoradiation or observation. Ann Surg 2007;246:734-740.
8. Evans DB, et al. Preoperative gemcitabine-based chemoradiation for patients with respectable
adenocarcinoma of the pancreatic head. J Clin Oncol 2008;26:3496-3502.
Reading: Hepatobiliary
Critical Topics:
1. Surgical treatment for benign tumors
2. Screening, diagnosis, staging, and surgical issues for HCC
3. Transplantation for HCC
4. Treatment of advanced HCC-TACE, chemotherapy
5. Surgical treatment of colorectal cancer liver metastases
6. Neoadjuvant and adjuvant treatment results for colorectal liver metastases
7. Portal vein embolization-indications, results, techniques, complications
8. Hilar and intrahepatic cholangiocarcinoma-diagnosis, treatment, outcomes
9. Gallbladder cancer-staging, surgical issues, adjuvant therapy
10. Surgical treatment of non-colorectal cancer liver metastases
References:
1. Mazzaferro V, et al. Liver transplantation for the treatment of small hepatocellular carcinomas
in patients with cirrhosis. N Engl J Med 1996;334:693-699
2. Shih SP, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg
2007;245:893-901.
3. Endo l, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and
determinants of outcome after resection. Ann Surg 2008;248:84-96.
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4. Jarnagin WR, et al. Staging, respectability, and outcome in 225 patients with hilar
cholangiocarcinoma. Ann Surg 2001;234:507-517.
Reading: Colorectal
Critical Topics:
1. Surgical approach-open vs. laparoscopic
2. Rectal cancer surgery-anatomy and techniques
3. Management of local recurrence of rectal cancer-extended resections, outcomes
4. Managing patients who present with resectable and nonresectable stage IV colorectal cancer
5. Screening, role of endoscopy in treatment
6. Genetics and familial syndromes-APC, HNPCC, and others
7. Results of adjuvant therapy trials for stage II and III disease
8. Chemotherapy options for stage IV disease
9. Role of radiation therapy in colorectal adenocarcinoma.
References:
1. Nagtegaal ID, et al. What is the role for the circumferential margin in the modern treatment of
rectal cancer? J Clin Oncol 2008;26:303-312.
2. Wichmann MW, et al. Effect of preoperative radiochemotherapy on lymph node retrieval after
resection of rectal cancer. Arch Surg 2002;137:206-210.
3. Weiser MR, et al. Surgical salvage of recurrent rectal cancer after transanal excision. Dis
Colon Rectum 2005;48:1169-1175.
4. Nash GM, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon
Rectum 2009;52:577-582.
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5. Ng SSM, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal
cancer: a prospective randomized tria. Ann Surg Oncol 2008;15:2418-2425
6. Sauer r, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl
J Med 2004;351:1731-1740.
7. Wong SL, et al. hospital lymph node examination rates and survival after resection for colon
cancer. JAMA 2007;298:2149-2154.
8. Tol J, et al. BRAF mutation in metastatic colorectal cancer. N Engl J Med 2009;361:98-99.
9. Grover S, et al. Colorectal cancer risk perception on the basis of genetic test results in
individuals at risk for Lynch syndrome. J Clin Oncol 2009;27:3981-3986.
10. Ribic CM, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracilbased adjuvant chemotherapy for colon cancer. N Engl J Med 2003;349:247-257.
11. West NP, et al. Complete mesocolic excision with central vascular ligation produces an
oncologically superior specimen compared with standard surgery for carcinoma of the colon. J
Clin Oncol 2010;28:272-278.
12. Jayne DG, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma:
3-year results of the UKMRCCLASICC trial group. J Clin Oncol 2007;25:3061-3068.
13. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically
assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050-2059
14. Bonjer HJ, et al. Laparoscopically assisted vs open colectomy for colon cancer: a metaanalysis. Arch Surg 2007;142:298-303.
15. Sargent D, et al. Evidence for cure by adjuvant therapy in colon cancer: observations based
on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol
2009;27:872-877.
16. Pawlik TM, et al. Effect of surgical margin status on survival and site of recurrence after
hepatic resection for colorectal metastases. Ann Surg 2005;241:715-722.
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17. Abdalla EK, et al. Recurrence and outcomes following hepatic resection, radiofrequency
ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg
2004;239:818-825.
18. Bilchik AJ, et al. Prognostic variables for resection of colorectal cancer hepatic metastases: an
evolving paradigm. J Clin Oncol 2008;26:5320-5321.
19. Benoist S, et al. Complete response of colorectal liver metastases after chemotherapy: does it
mean cure? J Clin Oncol 2005;23:9073-9078.
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