SurgOnc Today®

In this episode of SurgOnc Today®, Michail Mavros, MD, and Sonia T. Orcutt, MD from the University of Arkansas for Medical Sciences are joined by Jonathan R. Strosberg, MD, head of the Neuroendocrine Division in the Department of Gastrointestinal Oncology, Moffitt Cancer Center and Past President of the North American Neuroendocrine Tumor Society (NANETS), and Mary A. Maluccio, MD, MPH, chief of the Division of Surgical Oncology at LSU and medical director of the NET Louisiana program. Gastric NETs are often misunderstood neoplasms with recent updates in classification and management, and the panelists discuss the most up-to-date information on how to diagnose and manage gastric NETs.

This episode of SurgOnc Today®, features guest faculty, Astrid Botty Van Den Bruele, MD, and Meghan Flanagan, MD, MPH. In a contemporary group of patients diagnosed with contralateral axillary metastases (CAM), those selected for treatment with presumed curative intent experienced improved OS when compared to stage IV (M1) patients. The current literature, as well as some forthcoming data, adds additional support for re-evaluating the stage IV designation, in favor of N3, and consideration of curative intent treatment in this disease entity.

Historically, mastectomy was recommended for women with multiple ipsilateral breast cancer due to perceptions regarding high rates of local recurrence with breast conservation. A recent prospective clinical trial demonstrated that breast conservation therapy may be appropriate to consider for women with multiple ipsilateral breast cancer. This episode of SurgOnc Today® features Ashley Woodfin, MD, discussing with Judy C. Boughey, MD, and Kari Rosenkranz, MD, the findings of the Alliance Z11102 clinical trial and how to implement these into practice.

In patients with invasive breast cancer presenting with node positive disease, neoadjuvant chemotherapy is often recommended and can result in surgical downstaging in a significant proportion of cases. Management of the axilla in this setting has evolved. For those found to have a nodal pathologic complete response (ypN0), an axillary lymph node dissection (ALND) can potentially be avoided. Astrid Botty van den Bruele, MD, FACS, and Giacomo Montagna, MD, MPH, discuss the newly presented OPBC-04/EUBREAST-06 study, which supports omission of ALND in this population. The axillary staging techniques (SLNB vs TAD) are also addressed.

On SurgOnc Today®, Jeffrey J. Pelton, MD, and Randall P. Scheri, MD, discuss the use and efficiency of four-dimensional CT scanning in preoperatively localizing adenomas in patients with primary hyperparathyroidism prior to cervical exploration. The discussion includes: The anatomic body planes and the “fourth dimension” of CT scanning. How the 4D CT scan is performed and how this achieves localization of abnormal parathyroid glands. The role 4D CT scanning plays in the pre-operative work-up for primary hyperparathyroidism. What the surgeon wants to know from the radiologist on a 4D CT report. Potential risks and pitfalls in interpreting a 4D CT scan prior to proceeding with surgical exploration. Dr. Pelton and Dr. Scheri also discuss what the literature has reported on this subject, how they approach surgical exploration using the information and their own experiences with this test.

This session will review state of the art therapy for peritoneal mesothelioma. The discussion includes cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as well as systemic chemotherapy and immunotherapy. Edward Levine, MD, moderates this podcast and is Professor of Surgery and Chief, Surgical Oncology at Wake Forest University. Trang Nguyen, MD, is an Assistant Professor of Surgery at Indiana University and Sinziana Dumitra, MD, MSc, FRCSC, FSSO, is an Assistant Professor of Surgery at McGill University.

This episode of SurgOnc Today® features Tina Hieken, MD, from Mayo Clinic, in Rochester, MN, and Chair of the SSO Melanoma Disease Site Work Group interviews John Hyngstrom, MD, from the University of Utah and Michael Lowe, MD, MA, from Emory University. They will review recently reported phase II melanoma neoadjuvant studies and how the findings from these trials are important to surgical oncologists specializing in melanoma.

During this episode of SurgOnc Today®, Austin D. Williams, MD, Fox Chase Cancer Center, Zachary J. Brown, DO, New York University - Long Island School of Medicine, and Allison Martin, MD, University of Texas MD Anderson Cancer Center, discuss the various career options within surgical oncology, including breast, hepatobiliary and colorectal. The discussion covers information specific to each of these surgical oncology subspecialties and provides information important for any trainee who is contemplating a career as a surgical oncologist.

On SurgOnc Today®, J. Joshua Smith, MD, PhD, Glen Balch, MD, and Christina Bailey, MD, discuss modern rectal cancer trials and their relevance to clinical practice.

In this episode of SurgOnc Today, Alexander Parikh MD, MPH, FACS, FSSO, from the University of Texas, San Antonio and Chair of the SSO HPB Disease Site Work Group, and Julie Hallet, MD, M.Sc., FRCSC, from the University of Toronto, and Vice-Chair of the SSO HPB Disease Site Work Group, are joined by Flavio G. Rocha, MD, FACS, FSSO, from the Oregon Health and Science University and Susanne G. Warner, MD, from the Mayo Clinic Rochester. They discuss two important aspects of delivering neoadjuvant therapy for pancreatic adenocarcinoma: the use of staging laparoscopy and the assessment of response.

In this episode of SurgOnc Today, Genevieve Boland, MD, PhD, FSSO, of Massachusetts General Hospital – Vice Chair of the SSO Melanoma Disease Site Working Group is joined by fellow committee members, Rogerio Neves, MD, PhD, FACS, FSSO, from Moffitt Cancer Center and Amanda Kirane, MD, FACS, FSSO, from Stanford University. They discuss the current clinical application of tumor infiltrating lymphocytes (TILs) in melanoma, recent clinical trial results, advances in TILs production that have allowed for expanded patient access, and insight on appropriate patient or tumor selection for therapy.

In this episode of SurgOnc Today®, Chantal Reyna MD, Medical Director of Breast and Chief of Breast Surgery in the Upland, PA is joined by Jennifer Plichta MD, Associate Professor of Surgery at Duke University in Durham, NC and Chandler Cortina MD, Assistant Professor of Surgery and Chief of the Surgical Oncology Breast & Endocrine Service at the Medical College of Wisconsin at Medical College of Wisconsin in Milwaukee, WI. With the treatment of female breast cancer continuously evolving, the treatment of male breast cancer can be a challenge due to its rarity. This episode focuses on the current incidence, evaluation, and management of male breast cancer.

Desmoids are a unique subset of soft tissue tumors. While they can cause symptoms related to local progression, they do not metastasize and a subset have indolent behavior, in some cases regressing spontaneously. Because surgery for desmoids can be morbid and recurrence rates are high, non-operative treatment has become the preferred treatment strategy for desmoid patients. Active observation, regional therapies for anatomically appropriate cases and medical therapies can all be employed in patients with desmoid-type fibromatosis. Aimee M. Crago, MD, PhD, and Brian E. Kadera, MD, discuss cases requiring non-operative management to assist listeners in integrating recently published data into their practices.

In this episode of Surg Onc Today, Kimberly Washington, MD, Hepato-Pancreato-Biliary Surgeon at Texas Health Surgical Specialist/Texas Christian University in Fort Worth, Texas is joined by Jennifer Tseng MD, Medical Director of Breast Surgery, City of Hope Orange County, Associate Clinical Professor, Department of Surgery and Brian Sparkman, MD, MS, FACS, Complex General Surgical Oncology Fellow at Virginia Commonwealth University Medical Center, Richmond, VA. The initial year of practice can be a challenging yet pivotal learning experience. The episode offers expert advice, insider insights, and personal anecdotes to help ease your transition. Tune in for practical guidance that can assist you during this critical time.

In this episode of SurgOnc Today®, Doreen Agnese, MD, from The Ohio State University Medical Center is joined by Toan Nguyen, MD, from Lakeland Regional Health and Mark Robson, MD, from Memorial Sloan Kettering Cancer Center. Realizing that genetic testing is being performed more frequently and by many different providers for patients both with and without breast cancer, they discuss the management of non-BRCA breast cancer susceptibility genes.

In this episode of SurgOnc Today®, Mio Kitano, MD, MS, FACS, FSSO, Surgical Oncologist at UT Health San Antonio, TX, is joined by Mashaal Dhir, MD, FACS, FSSO, Surgical Oncologist and Section Chief of HPB Surgery at The SUNY Upstate Medical University in Syracuse, NY, and Nathan Bahary, MD, PhD, Division Chief of Medical Oncology at the Allegheny Health Network Cancer Institute and Director of AHNCI Clinical Research in Pittsburgh, PA. They discuss the most up-to-date information on how to diagnose and manage small bowel NET. Moderator: Mio Kitano, MD, MS, FACS, FSSO - UT Health San Antonio Faculty: Mashaal Dhir, MD, FACS, FSSO - SUNY Upstate Medical University Nathan Bahary, MD, PhD - Allegheny Health Network

On SurgOnc Today®, Patrick S. Sullivan, MD, Maria Diab, MD, and Nader Hanna, MD, discuss the use of liquid biopsy or ctDNA to identify molecular disease prior to clinically detectable disease. Molecular detection of ctDNA can be used to detect minimal residual disease (MRD) which is residual cancer cells detected only by molecular techniques but not by conventional testing. Molecular testing of ctDNA can also be used to detect molecular relapse. This allows the molecular detection of occult disease during adjuvant therapy or during surveillance. This information can be prognostic and help determine patients with increased risk of recurrent disease who may benefit from adjuvant therapy and targeted chemotherapy. It can also be used for prediction for adjuvant chemotherapy. In addition it can be used for de-escalation of chemotherapy by identifying patients who would not gain the benefit of chemotherapy. There are 2 approaches for detecting MRD. One is tumor agnostic and the second is tumor informed. The tumor informed has higher sensitivity by identifying mutations in the tumor tissue and tracking these mutations in the plasma.

In this episode of SurgOnc Today®, Dr. Julie Hallet from the University of Toronto, and Vice-Chair of the SSO HPB disease site working group, is joinded by Dr. James R. Howe from the University of Iowa and Dr. Nadine Mallak from the Oregon Health and Science University. They discuss how somatostatin receptor PET imaging, such as DOTATE-PET, can be used to guide and support the surgical management of pancreatic neuroendocrine tumors. Moderator: Julie Hallet MD, Msc; Associate Professor of Surgery. University of Toronto, Toronto, Canada; Surgical Oncologist, Susan Leslie Clinic for Neuroendocrine Tumors – Sunnybrook Health Sciences Centre, Toronto, Canada Vice-Chair, HPB DSWG, SSO Faculty: James R. Howe, MD Professor of Surgery and Director of Surgical Oncology and Endocrine Surgery, Roy J. and Lucille A. Carver University of Iowa College of Medicine, Iowa City, Iowa Nadine Mallak, MD Associate Professor, Department of Diagnostic Radiology, Nuclear Medicine and Body Imaging sections Director, PET/MRI, Clinical, Oregon Health and Science University, Portland, OR References NANETS guidelines for the surgical management of pancreatic neuroendocrine tumors https://nanets.net/images/guidelines/2020_NANETS_Consensus_Paper_on_the_Surgical_Management_of_Pancreatic_Neuroendocrine_Tumors.pdf SNMMI appropriate use criteria for somatostatin receptor PET imaging in neuroendocrine tumors https://s3.amazonaws.com/rdcms-snmmi/files/production/public/Quality/jnm202275_New%20-%20revised.pdf

During this episode of SurgOnc Today®, Valerie P. Grignol, MD, Vice Chair of the SSO Sarcoma Disease Site Work Group, Timur Mitin, MD, PhD, Arun Singh, MD, and Neha Goel, MD, discuss the evaluation, treatment and management of primary and radiation induced angiosarcoma of the breast through a case based discussion.

In this episode of SurgOnc Today®, Judy Boughey, MD, from the Mayo Clinic in Rochester, MN, and Vice Chair of the SSO Breast Disease Site Work Group, discusses with her colleagues how they manage a missing clipped axillary lymph node. She is joined by Puneet Singh, MD, from MD Anderson Cancer Center and Firas Eladoumikdachi, MD, from Rutgers Cancer Institute of New Jersey. Their discussion is focused on patients with node positive breast cancer who were treated with neoadjuvant chemotherapy.