Thoracic Surgery News (Archived)

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Viking Olov Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Viking Olov Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Viking Olov Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

What makes a Cardiothoracic training program great? For many it means that the program “leads” the field in surgical knowledge, blazing a path towards discovery. To oth­ers it means the program trains future surgeons well by teaching them how to operate. Still others feel it is a program with a rich history and an esteemed group of surgeons on its board …the list could go on and on. The Joint Council on Thoracic Surgery Education (JCTSE) recently has begun to focus on identify­ing areas within surgical education that makes a program stand above the rest.

To some, searching for what makes a Cardiothoracic program “great” is pure­ly subjective like a quest for the world’s greatest donut. The goal here is not to form a simple rank list of the most out­standing CT programs; rather, the JCTSE aims to identify traits of pro­grams that support the American Board of Thoracic Surgery’s mission to “pro­tect the public by establishing and main­
taining high standards in thoracic surgery.” The mere ranking of programs in a neat and orderly line likely does not hold much educational purpose. The identification of “great” traits though, does have purpose and will help deliver specific goals from broad educational principals.

The JCTSE and the Thoracic Surgery Residents Association (TSRA) have re­cently taken a first step in collecting these traits of greatness by sending out
a preliminary survey to current cardio­thoracic (CT) residents. The survey con­sisted of 50 questions addressing the relative importance of multiple aspects of CT surgery training programs and ini­tial findings varied from the expected to the surprising. Traditional areas of im­portance such as the reputation of the program, the expectation of trainees functioning as operating surgeon, help in finding employment and a high volume and complexity of cases were at the top
of the list. Surprisingly, other areas queried such as the program’s facilities or if the program is 2 or 3 years were not felt to be important in making a program “outstanding” by current CT residents.

Now that this preliminary data has been collected, a more scientific survey is being developed to administer to fu­ture generations of CT residents. The data from which may ultimately serve as a useful guide to “raise all boats” towards greatness in Cardiothoracic training.

What makes a Cardiothoracic training program great? For many it means that the program “leads” the field in surgical knowledge, blazing a path towards discovery. To oth­ers it means the program trains future surgeons well by teaching them how to operate. Still others feel it is a program with a rich history and an esteemed group of surgeons on its board …the list could go on and on. The Joint Council on Thoracic Surgery Education (JCTSE) recently has begun to focus on identify­ing areas within surgical education that makes a program stand above the rest.

To some, searching for what makes a Cardiothoracic program “great” is pure­ly subjective like a quest for the world’s greatest donut. The goal here is not to form a simple rank list of the most out­standing CT programs; rather, the JCTSE aims to identify traits of pro­grams that support the American Board of Thoracic Surgery’s mission to “pro­tect the public by establishing and main­
taining high standards in thoracic surgery.” The mere ranking of programs in a neat and orderly line likely does not hold much educational purpose. The identification of “great” traits though, does have purpose and will help deliver specific goals from broad educational principals.

The JCTSE and the Thoracic Surgery Residents Association (TSRA) have re­cently taken a first step in collecting these traits of greatness by sending out
a preliminary survey to current cardio­thoracic (CT) residents. The survey con­sisted of 50 questions addressing the relative importance of multiple aspects of CT surgery training programs and ini­tial findings varied from the expected to the surprising. Traditional areas of im­portance such as the reputation of the program, the expectation of trainees functioning as operating surgeon, help in finding employment and a high volume and complexity of cases were at the top
of the list. Surprisingly, other areas queried such as the program’s facilities or if the program is 2 or 3 years were not felt to be important in making a program “outstanding” by current CT residents.

Now that this preliminary data has been collected, a more scientific survey is being developed to administer to fu­ture generations of CT residents. The data from which may ultimately serve as a useful guide to “raise all boats” towards greatness in Cardiothoracic training.

What makes a Cardiothoracic training program great? For many it means that the program “leads” the field in surgical knowledge, blazing a path towards discovery. To oth­ers it means the program trains future surgeons well by teaching them how to operate. Still others feel it is a program with a rich history and an esteemed group of surgeons on its board …the list could go on and on. The Joint Council on Thoracic Surgery Education (JCTSE) recently has begun to focus on identify­ing areas within surgical education that makes a program stand above the rest.

To some, searching for what makes a Cardiothoracic program “great” is pure­ly subjective like a quest for the world’s greatest donut. The goal here is not to form a simple rank list of the most out­standing CT programs; rather, the JCTSE aims to identify traits of pro­grams that support the American Board of Thoracic Surgery’s mission to “pro­tect the public by establishing and main­
taining high standards in thoracic surgery.” The mere ranking of programs in a neat and orderly line likely does not hold much educational purpose. The identification of “great” traits though, does have purpose and will help deliver specific goals from broad educational principals.

The JCTSE and the Thoracic Surgery Residents Association (TSRA) have re­cently taken a first step in collecting these traits of greatness by sending out
a preliminary survey to current cardio­thoracic (CT) residents. The survey con­sisted of 50 questions addressing the relative importance of multiple aspects of CT surgery training programs and ini­tial findings varied from the expected to the surprising. Traditional areas of im­portance such as the reputation of the program, the expectation of trainees functioning as operating surgeon, help in finding employment and a high volume and complexity of cases were at the top
of the list. Surprisingly, other areas queried such as the program’s facilities or if the program is 2 or 3 years were not felt to be important in making a program “outstanding” by current CT residents.

Now that this preliminary data has been collected, a more scientific survey is being developed to administer to fu­ture generations of CT residents. The data from which may ultimately serve as a useful guide to “raise all boats” towards greatness in Cardiothoracic training.

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Viking Olov Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Viking Olov Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Viking Olov Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

What makes a Cardiothoracic training program great? For many it means that the program “leads” the field in surgical knowledge, blazing a path towards discovery. To oth­ers it means the program trains future surgeons well by teaching them how to operate. Still others feel it is a program with a rich history and an esteemed group of surgeons on its board …the list could go on and on. The Joint Council on Thoracic Surgery Education (JCTSE) recently has begun to focus on identify­ing areas within surgical education that makes a program stand above the rest.

To some, searching for what makes a Cardiothoracic program “great” is pure­ly subjective like a quest for the world’s greatest donut. The goal here is not to form a simple rank list of the most out­standing CT programs; rather, the JCTSE aims to identify traits of pro­grams that support the American Board of Thoracic Surgery’s mission to “pro­tect the public by establishing and main­
taining high standards in thoracic surgery.” The mere ranking of programs in a neat and orderly line likely does not hold much educational purpose. The identification of “great” traits though, does have purpose and will help deliver specific goals from broad educational principals.

The JCTSE and the Thoracic Surgery Residents Association (TSRA) have re­cently taken a first step in collecting these traits of greatness by sending out
a preliminary survey to current cardio­thoracic (CT) residents. The survey con­sisted of 50 questions addressing the relative importance of multiple aspects of CT surgery training programs and ini­tial findings varied from the expected to the surprising. Traditional areas of im­portance such as the reputation of the program, the expectation of trainees functioning as operating surgeon, help in finding employment and a high volume and complexity of cases were at the top
of the list. Surprisingly, other areas queried such as the program’s facilities or if the program is 2 or 3 years were not felt to be important in making a program “outstanding” by current CT residents.

Now that this preliminary data has been collected, a more scientific survey is being developed to administer to fu­ture generations of CT residents. The data from which may ultimately serve as a useful guide to “raise all boats” towards greatness in Cardiothoracic training.

What makes a Cardiothoracic training program great? For many it means that the program “leads” the field in surgical knowledge, blazing a path towards discovery. To oth­ers it means the program trains future surgeons well by teaching them how to operate. Still others feel it is a program with a rich history and an esteemed group of surgeons on its board …the list could go on and on. The Joint Council on Thoracic Surgery Education (JCTSE) recently has begun to focus on identify­ing areas within surgical education that makes a program stand above the rest.

To some, searching for what makes a Cardiothoracic program “great” is pure­ly subjective like a quest for the world’s greatest donut. The goal here is not to form a simple rank list of the most out­standing CT programs; rather, the JCTSE aims to identify traits of pro­grams that support the American Board of Thoracic Surgery’s mission to “pro­tect the public by establishing and main­
taining high standards in thoracic surgery.” The mere ranking of programs in a neat and orderly line likely does not hold much educational purpose. The identification of “great” traits though, does have purpose and will help deliver specific goals from broad educational principals.

The JCTSE and the Thoracic Surgery Residents Association (TSRA) have re­cently taken a first step in collecting these traits of greatness by sending out
a preliminary survey to current cardio­thoracic (CT) residents. The survey con­sisted of 50 questions addressing the relative importance of multiple aspects of CT surgery training programs and ini­tial findings varied from the expected to the surprising. Traditional areas of im­portance such as the reputation of the program, the expectation of trainees functioning as operating surgeon, help in finding employment and a high volume and complexity of cases were at the top
of the list. Surprisingly, other areas queried such as the program’s facilities or if the program is 2 or 3 years were not felt to be important in making a program “outstanding” by current CT residents.

Now that this preliminary data has been collected, a more scientific survey is being developed to administer to fu­ture generations of CT residents. The data from which may ultimately serve as a useful guide to “raise all boats” towards greatness in Cardiothoracic training.

What makes a Cardiothoracic training program great? For many it means that the program “leads” the field in surgical knowledge, blazing a path towards discovery. To oth­ers it means the program trains future surgeons well by teaching them how to operate. Still others feel it is a program with a rich history and an esteemed group of surgeons on its board …the list could go on and on. The Joint Council on Thoracic Surgery Education (JCTSE) recently has begun to focus on identify­ing areas within surgical education that makes a program stand above the rest.

To some, searching for what makes a Cardiothoracic program “great” is pure­ly subjective like a quest for the world’s greatest donut. The goal here is not to form a simple rank list of the most out­standing CT programs; rather, the JCTSE aims to identify traits of pro­grams that support the American Board of Thoracic Surgery’s mission to “pro­tect the public by establishing and main­
taining high standards in thoracic surgery.” The mere ranking of programs in a neat and orderly line likely does not hold much educational purpose. The identification of “great” traits though, does have purpose and will help deliver specific goals from broad educational principals.

The JCTSE and the Thoracic Surgery Residents Association (TSRA) have re­cently taken a first step in collecting these traits of greatness by sending out
a preliminary survey to current cardio­thoracic (CT) residents. The survey con­sisted of 50 questions addressing the relative importance of multiple aspects of CT surgery training programs and ini­tial findings varied from the expected to the surprising. Traditional areas of im­portance such as the reputation of the program, the expectation of trainees functioning as operating surgeon, help in finding employment and a high volume and complexity of cases were at the top
of the list. Surprisingly, other areas queried such as the program’s facilities or if the program is 2 or 3 years were not felt to be important in making a program “outstanding” by current CT residents.

Now that this preliminary data has been collected, a more scientific survey is being developed to administer to fu­ture generations of CT residents. The data from which may ultimately serve as a useful guide to “raise all boats” towards greatness in Cardiothoracic training.

NEW ORLEANS – An association has been reported between elevated proteo­glycan biopsy results and severe mitral valve prolapse.

Dr. Paolo Romanelli and his associates compared eight patients with echocar­diography-proven severe mitral valve prolapse (MVP) and six controls with no cardiac symptoms. They took two 4-mm punch biopsies from normal-ap­pearing forearm skin of each participant to test for proteoglycan mucin levels.

Dr. Romanelli’s study, presented at the annual meeting of the American Acade­my of Dermatology demonstrated that quantitative proteoglycan analysis was greater among patients with MVP (0.6 mg/g), compared with controls (0.4 mg/g). In addition, semiquantitative as­sessment of proteoglycan deposition by hematoxylin-eosin staining and colloidal iron staining showed a mean 3.4 in MVP patients, compared with 1.0 in controls, noted Dr. Romanelli of the University of Miami. All participants were younger than 55 years. All of the MVP patients were comorbid with conditions that in­cluded atrial fibrillation, palpitations, and mild chest discomfort.

The study findings need to be validat­ed, Dr. Romanelli said. Nevertheless, he said he foresees a time when a skin biop­sy will predict the subset of patients at greatest risk for arrhythmias and sudden death from MVP.

I have checked the following facts in my story: (Please initial each.)

Dr. Romanelli said that he had no rel­evant disclosures. 

NEW ORLEANS – An association has been reported between elevated proteo­glycan biopsy results and severe mitral valve prolapse.

Dr. Paolo Romanelli and his associates compared eight patients with echocar­diography-proven severe mitral valve prolapse (MVP) and six controls with no cardiac symptoms. They took two 4-mm punch biopsies from normal-ap­pearing forearm skin of each participant to test for proteoglycan mucin levels.

Dr. Romanelli’s study, presented at the annual meeting of the American Acade­my of Dermatology demonstrated that quantitative proteoglycan analysis was greater among patients with MVP (0.6 mg/g), compared with controls (0.4 mg/g). In addition, semiquantitative as­sessment of proteoglycan deposition by hematoxylin-eosin staining and colloidal iron staining showed a mean 3.4 in MVP patients, compared with 1.0 in controls, noted Dr. Romanelli of the University of Miami. All participants were younger than 55 years. All of the MVP patients were comorbid with conditions that in­cluded atrial fibrillation, palpitations, and mild chest discomfort.

The study findings need to be validat­ed, Dr. Romanelli said. Nevertheless, he said he foresees a time when a skin biop­sy will predict the subset of patients at greatest risk for arrhythmias and sudden death from MVP.

I have checked the following facts in my story: (Please initial each.)

Dr. Romanelli said that he had no rel­evant disclosures. 

NEW ORLEANS – An association has been reported between elevated proteo­glycan biopsy results and severe mitral valve prolapse.

Dr. Paolo Romanelli and his associates compared eight patients with echocar­diography-proven severe mitral valve prolapse (MVP) and six controls with no cardiac symptoms. They took two 4-mm punch biopsies from normal-ap­pearing forearm skin of each participant to test for proteoglycan mucin levels.

Dr. Romanelli’s study, presented at the annual meeting of the American Acade­my of Dermatology demonstrated that quantitative proteoglycan analysis was greater among patients with MVP (0.6 mg/g), compared with controls (0.4 mg/g). In addition, semiquantitative as­sessment of proteoglycan deposition by hematoxylin-eosin staining and colloidal iron staining showed a mean 3.4 in MVP patients, compared with 1.0 in controls, noted Dr. Romanelli of the University of Miami. All participants were younger than 55 years. All of the MVP patients were comorbid with conditions that in­cluded atrial fibrillation, palpitations, and mild chest discomfort.

The study findings need to be validat­ed, Dr. Romanelli said. Nevertheless, he said he foresees a time when a skin biop­sy will predict the subset of patients at greatest risk for arrhythmias and sudden death from MVP.

I have checked the following facts in my story: (Please initial each.)

Dr. Romanelli said that he had no rel­evant disclosures. 

Hospitals and hospitalists should ex­pect more aggressive enforcement of protected health information reg­ulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which

********* TEXT BREAK *********HHS found had violated 41 patients’ rights by failing to provide them with ac­cess to their own medical records.

Dr. Chad Whelan, director of the di­vision of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforce­ment of HIPAA is coming.

<[stk -3.7]>“Given the large fines and the high-pro­file institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”<[etk]>

<[stk -3]>To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health infor­mation across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.<[etk]>

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share informa­tion,” he said. “The terrifying thing about computers, smartphones, and elec­tronic medical records is that [they make it] amazingly easy to store, access, and share information.

<[stk -1]>“Medical centers and hospitalists must be aware of this tension between im­proving care through information access and sharing and the risk to confidential­ity through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” he said.<[etk]>

<[stk -3]>Office of Civil Rights director Georgina Verdugo said as much in a statement in­volving the MassGen settlement. “We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA en­forcement. It is a covered entity’s respon­sibility to protect its patients’ health information,” Ms. Verdugo said.<[etk]>

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and in­cluded patients with HIV and AIDS, ac­cording to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying infor­mation such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the infor­mation on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating pro­visions of the HIPAA Privacy Rule.”

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to en­hance protection of protected health in­formation when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryp­tion and USB drive encryption.

“After these policies and procedures are issued, we will be providing manda­tory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that can cause trouble. “It is far more likely that a well-meaning employee simply forgets the ba­sics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer
hardware, such as hard drives, CDs, and laptops, he said. But “with the increased availability of electronic medical records, it will only become easier to have infor­mation about patients in portable for­mats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

<[stk -3]>The rise of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. “How many peo­ple have patient information stored or ac­cessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easi­ly accessed through a smartphone. Hos­pitals need to develop policies around encryption and support end users in en­crypting the multiple devices they may use to levels that are acceptable to HHS.”<[etk]>

I have checked the following facts in my story: (Please initial each.)

·Drug names and dosages n.a.

<[stk -3]>In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information man­agement, but also need to help employees make certain any data-storage or trans­mission devices they use are HIPAA-com­pliant, Dr. Whelan said. <[etk]>

<[stk -3]>“Hospitalists should be involved in both policy development and process imple­mentation to assure that the benefits of electronic data storage are not lost in or­der to reduce the risk of HIPAA viola­tion,” he added.

Hospitals and hospitalists should ex­pect more aggressive enforcement of protected health information reg­ulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which

********* TEXT BREAK *********HHS found had violated 41 patients’ rights by failing to provide them with ac­cess to their own medical records.

Dr. Chad Whelan, director of the di­vision of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforce­ment of HIPAA is coming.

<[stk -3.7]>“Given the large fines and the high-pro­file institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”<[etk]>

<[stk -3]>To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health infor­mation across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.<[etk]>

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share informa­tion,” he said. “The terrifying thing about computers, smartphones, and elec­tronic medical records is that [they make it] amazingly easy to store, access, and share information.

<[stk -1]>“Medical centers and hospitalists must be aware of this tension between im­proving care through information access and sharing and the risk to confidential­ity through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” he said.<[etk]>

<[stk -3]>Office of Civil Rights director Georgina Verdugo said as much in a statement in­volving the MassGen settlement. “We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA en­forcement. It is a covered entity’s respon­sibility to protect its patients’ health information,” Ms. Verdugo said.<[etk]>

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and in­cluded patients with HIV and AIDS, ac­cording to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying infor­mation such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the infor­mation on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating pro­visions of the HIPAA Privacy Rule.”

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to en­hance protection of protected health in­formation when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryp­tion and USB drive encryption.

“After these policies and procedures are issued, we will be providing manda­tory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that can cause trouble. “It is far more likely that a well-meaning employee simply forgets the ba­sics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer
hardware, such as hard drives, CDs, and laptops, he said. But “with the increased availability of electronic medical records, it will only become easier to have infor­mation about patients in portable for­mats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

<[stk -3]>The rise of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. “How many peo­ple have patient information stored or ac­cessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easi­ly accessed through a smartphone. Hos­pitals need to develop policies around encryption and support end users in en­crypting the multiple devices they may use to levels that are acceptable to HHS.”<[etk]>

I have checked the following facts in my story: (Please initial each.)

·Drug names and dosages n.a.

<[stk -3]>In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information man­agement, but also need to help employees make certain any data-storage or trans­mission devices they use are HIPAA-com­pliant, Dr. Whelan said. <[etk]>

<[stk -3]>“Hospitalists should be involved in both policy development and process imple­mentation to assure that the benefits of electronic data storage are not lost in or­der to reduce the risk of HIPAA viola­tion,” he added.

Hospitals and hospitalists should ex­pect more aggressive enforcement of protected health information reg­ulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which

********* TEXT BREAK *********HHS found had violated 41 patients’ rights by failing to provide them with ac­cess to their own medical records.

Dr. Chad Whelan, director of the di­vision of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforce­ment of HIPAA is coming.

<[stk -3.7]>“Given the large fines and the high-pro­file institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”<[etk]>

<[stk -3]>To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health infor­mation across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.<[etk]>

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share informa­tion,” he said. “The terrifying thing about computers, smartphones, and elec­tronic medical records is that [they make it] amazingly easy to store, access, and share information.

<[stk -1]>“Medical centers and hospitalists must be aware of this tension between im­proving care through information access and sharing and the risk to confidential­ity through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” he said.<[etk]>

<[stk -3]>Office of Civil Rights director Georgina Verdugo said as much in a statement in­volving the MassGen settlement. “We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA en­forcement. It is a covered entity’s respon­sibility to protect its patients’ health information,” Ms. Verdugo said.<[etk]>

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and in­cluded patients with HIV and AIDS, ac­cording to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying infor­mation such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the infor­mation on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating pro­visions of the HIPAA Privacy Rule.”

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to en­hance protection of protected health in­formation when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryp­tion and USB drive encryption.

“After these policies and procedures are issued, we will be providing manda­tory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that can cause trouble. “It is far more likely that a well-meaning employee simply forgets the ba­sics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer
hardware, such as hard drives, CDs, and laptops, he said. But “with the increased availability of electronic medical records, it will only become easier to have infor­mation about patients in portable for­mats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

<[stk -3]>The rise of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. “How many peo­ple have patient information stored or ac­cessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easi­ly accessed through a smartphone. Hos­pitals need to develop policies around encryption and support end users in en­crypting the multiple devices they may use to levels that are acceptable to HHS.”<[etk]>

I have checked the following facts in my story: (Please initial each.)

·Drug names and dosages n.a.

<[stk -3]>In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information man­agement, but also need to help employees make certain any data-storage or trans­mission devices they use are HIPAA-com­pliant, Dr. Whelan said. <[etk]>

<[stk -3]>“Hospitalists should be involved in both policy development and process imple­mentation to assure that the benefits of electronic data storage are not lost in or­der to reduce the risk of HIPAA viola­tion,” he added.

DETROIT – Rural hospitals will need to devise unique strategies to enhance hiring and retention in the face of a looming shortage of almost 30,000 sur­geons over the next 20 years.

“We think this shortage will result in competition between urban and rural hospitals, maybe perpetuating in bid­ding wars,” Dr. Thomas E. Williams Jr. said at the annual meeting of the Central Surgical Association.

“In a sense, this shortage could be a perfect storm; an imperative for both the urban and rural hospitals we see in America today.”

The researchers previously reported that an estimated 101,838 surgeons will need to be trained by 2030 to address a projected shortage in the United States of 29,138 surgeons in seven surgical spe­cialties: obstetrics and gynecology, or­thopedic surgery, general surgery, otolaryngology, urology, neurosurgery,
and thoracic surgery (Ann. Surg. 2009;250:590-7). I’ve searched and can’t find the print reference. Help?—EW The trick is to search by the article name in Google. I got abut 5 different versions that way./CNW»

The current analysis went one step fur­ther, focusing on the average recruit­ment needs for the seven specialties in rural vs. urban hospitals in light of the projected U.S. population of 364 million by 2030. The model assumed that there will be equal population growth in urban and rural areas; that rural hospitals will need to recruit obstetric/gynecologic, orthopedic, and general surgeons; and that the percentage of the population re­ceiving care at urban and rural hospitals will remain constant, Dr. Williams ex­plained.

Currently, the American Hospital As­sociation estimates that there are 3,012 urban hospitals in the United States. serving 82% of the population or 253 million Americans, and 1,998 rural hos­pitals serving 18% or 56 million Ameri­cans.

Based on these assumptions, the total number of surgical hires over the next 19 years will be 83,507 for urban hospitals and 13,953 for rural hospitals. This means urban hospitals must hire and re­tain 4,175 surgeons per year or 27.7 sur­geons per hospital, while rural hospitals will need to hire 698 surgeons per year or 7 surgeons per hospital, said Dr. Williams «not facs»of the department of surgery at Ohio State University in Columbus.

While the recruitment goals for urban hospitals might appear more daunting, rural hospitals are already facing a dra­matic loss of general surgeons.

“In rural hospitals, general surgery is essential,” he said. “[General surgeons] account for 60% of the revenue. What’s happening now is that about 34% of general surgeons are notifying their ad­ministrators of retiring or leaving in 2 years. Thirty-three percent of rural hos­pitals are recruiting now.”

Factors that might make rural re­cruitment more difficult include profes­sional and social isolation, cross coverage, insufficient training for the va­riety of procedures performed and pathologies encountered, and women’s preference for urban areas, he said.

Factors that positively influence rural recruitment include the chance to be a critical part of the community, indepen­dence, the wide spectrum of procedures, and hailing from a rural area.

One strategy that can tip a surgeon to­ward a rural hospital is doing a residen­cy in a rural training program. The researchers estimate that half of gener­al surgery residents who rotate through such a program will go on to practice in rural towns.

“It’s to the advantage of rural hospital administrators to establish rotations with medical schools in their hospitals, so they can have the opportunity to recruit some of the people that rotate through their rural hospitals,” Dr. Williams said.

Consideration of the needs of the sur­geon’s family is another factor. Typical­
ly, this will be a two-income family that values education and will need either good public schools or the means to pay for private schools. Most couples will also have educational debts, some as high as $400,000 for a two-physician cou­ple. Thus, educational loan repayment could be a potential “trump card” for rur­al hospitals in the future, he said.

Rural hospitals are already throw­ing out the wel­come mat. Most offer hiring incen­tives such as a re­location allowance; signing bonus; health, dis­ability, and life in­surance; and malpractice coverage. Educational loan forgiveness was offered by 38% of hos­pitals last year, up 7% from 2009, Dr. Williams said. Still, competition for new hires is fierce.

“In many general surgery programs in the United States, senior residents are re­ceiving as many as 50 offers for employ­ment today,” he said.

To illustrate the point, Dr. Williams showed a recent classified ad in the New England Journal of Medicine offering a starting base salary of $600,000 for an or­thopedic surgeon in coastal Georgia plus a sign-on and relocation bonus, full ben­efits, and a high-yield bonus. This is nearly double the median starting salary of $370,000 for an orthopedic surgeon identified in a recent Cejka Executive Search survey, he pointed out.

Median starting salaries for the seven surgical specialties studied ranged from a low of $260,000 for a general surgeon to a high of $450,000 for a neurosurgeon in the Cejka survey.

Invited discussant Dr. Nathaniel Sop­er, «facs»chair of the department of surgery at Northwestern University in Chicago, said, “It may end up being ultimately that these bidding wars are good for general surgeons, but I think it’s not going to be good for the population we serve, as there is going to be a shortage unless something is done.”

Dr. Sober suggested that the basic problem is not so much the division be­tween rural vs. urban, but the supply of surgeons, and asked what can be done to meet the estimated shortfall. He also questioned the model’s assumption that the population would remain equal in rural and urban areas.

Co-author and colleague Dr. Bhag­wan Satiani replied that the analysis in­cluded a simplified version of the federal model used to calculate supply and de­mand, but added that every projection in the last 50-75 years has been wrong. “You have to look at this model and say, ‘This is the best we can do right now,” he said.

According to Dr. Satiani, one of the best ways to increase the rural surgeon supply is through a comprehensive med­ical school rural program (MSRP). “If you took 10 medical students out of the class and put them into the MSRP pro­
gram, you could double the number of rural surgeons. That’s how important that is,” said Dr. Satiani, «facs»medical director of the vascular surgery laboratory and a professor of clinical surgery at Ohio State University.

A recently published report from the Physician Shortage Area Program (PSAP) at Jefferson Medical College in Philadelphia pro­vides a similar cal­culation for rural physicians and re­ports that 79%-87% of graduates from the two MSRPs with long-range rural out­comes – the PSAP and University of Minnesota at Duluth – remained in rur­al practice for up to 20 years (Acad. Med. 2011;86:272). It also notes that the Af­fordable Care Act authorized a new Rur­al Physician Training Grants program to provide grants to medical schools to de­velop or expand MSRPs.

Only 25 of the roughly 250 medical schools have general surgery programs, and just 10% of these could be consid­ered programs that attract rural sur­geons, according to Dr. Satiani. “I think American surgery is going to have to give this a separate tract within residency programs.”

Audience member Dr. Mark Malan­goni, «facs»associate executive director of the American Board of Surgery in Philadel­phia, pointed out that in such rural areas as Wyoming, the closest medical school is more than 1,000 miles away in Wash­ington state.

He suggested that one way to link rural hospitals and to counteract the professional isolation experienced by some rural physicians is through Web-based surgeon-to-surgeon consultations, an idea strongly supported by a recent survey of American College of Surgeons fellows.

If a new medical school were located in a rural area, Dr. Satiani said it could feed two to three nearby states, but not one of the new medical schools built in the last 5 years has been in truly rural ar­eas.

Finally, several audience members sug­gested that efforts need to be made to eliminate the perception among resi­dents that surgical specialists are some­how better than general surgeons.

“It’s the one-on-one thing that’s going to work with the residents, because all they see are these super-specialists,” Dr. Satiani said. “I think it has to come from the programs and the leadership; defin­ing general surgery better, even going as far as changing the name, if that be­comes an important issue.”

When asked in an interview what that new name might be, Dr. Satiani said the terms “master surgeon” and “omni sur­geon” have been floated, with master surgeon more likely to resonate with the general public.

I have checked the following facts in my story: (Please initial each.)

The authors reported no conflicts of interest. 

DETROIT – Rural hospitals will need to devise unique strategies to enhance hiring and retention in the face of a looming shortage of almost 30,000 sur­geons over the next 20 years.

“We think this shortage will result in competition between urban and rural hospitals, maybe perpetuating in bid­ding wars,” Dr. Thomas E. Williams Jr. said at the annual meeting of the Central Surgical Association.

“In a sense, this shortage could be a perfect storm; an imperative for both the urban and rural hospitals we see in America today.”

The researchers previously reported that an estimated 101,838 surgeons will need to be trained by 2030 to address a projected shortage in the United States of 29,138 surgeons in seven surgical spe­cialties: obstetrics and gynecology, or­thopedic surgery, general surgery, otolaryngology, urology, neurosurgery,
and thoracic surgery (Ann. Surg. 2009;250:590-7). I’ve searched and can’t find the print reference. Help?—EW The trick is to search by the article name in Google. I got abut 5 different versions that way./CNW»

The current analysis went one step fur­ther, focusing on the average recruit­ment needs for the seven specialties in rural vs. urban hospitals in light of the projected U.S. population of 364 million by 2030. The model assumed that there will be equal population growth in urban and rural areas; that rural hospitals will need to recruit obstetric/gynecologic, orthopedic, and general surgeons; and that the percentage of the population re­ceiving care at urban and rural hospitals will remain constant, Dr. Williams ex­plained.

Currently, the American Hospital As­sociation estimates that there are 3,012 urban hospitals in the United States. serving 82% of the population or 253 million Americans, and 1,998 rural hos­pitals serving 18% or 56 million Ameri­cans.

Based on these assumptions, the total number of surgical hires over the next 19 years will be 83,507 for urban hospitals and 13,953 for rural hospitals. This means urban hospitals must hire and re­tain 4,175 surgeons per year or 27.7 sur­geons per hospital, while rural hospitals will need to hire 698 surgeons per year or 7 surgeons per hospital, said Dr. Williams «not facs»of the department of surgery at Ohio State University in Columbus.

While the recruitment goals for urban hospitals might appear more daunting, rural hospitals are already facing a dra­matic loss of general surgeons.

“In rural hospitals, general surgery is essential,” he said. “[General surgeons] account for 60% of the revenue. What’s happening now is that about 34% of general surgeons are notifying their ad­ministrators of retiring or leaving in 2 years. Thirty-three percent of rural hos­pitals are recruiting now.”

Factors that might make rural re­cruitment more difficult include profes­sional and social isolation, cross coverage, insufficient training for the va­riety of procedures performed and pathologies encountered, and women’s preference for urban areas, he said.

Factors that positively influence rural recruitment include the chance to be a critical part of the community, indepen­dence, the wide spectrum of procedures, and hailing from a rural area.

One strategy that can tip a surgeon to­ward a rural hospital is doing a residen­cy in a rural training program. The researchers estimate that half of gener­al surgery residents who rotate through such a program will go on to practice in rural towns.

“It’s to the advantage of rural hospital administrators to establish rotations with medical schools in their hospitals, so they can have the opportunity to recruit some of the people that rotate through their rural hospitals,” Dr. Williams said.

Consideration of the needs of the sur­geon’s family is another factor. Typical­
ly, this will be a two-income family that values education and will need either good public schools or the means to pay for private schools. Most couples will also have educational debts, some as high as $400,000 for a two-physician cou­ple. Thus, educational loan repayment could be a potential “trump card” for rur­al hospitals in the future, he said.

Rural hospitals are already throw­ing out the wel­come mat. Most offer hiring incen­tives such as a re­location allowance; signing bonus; health, dis­ability, and life in­surance; and malpractice coverage. Educational loan forgiveness was offered by 38% of hos­pitals last year, up 7% from 2009, Dr. Williams said. Still, competition for new hires is fierce.

“In many general surgery programs in the United States, senior residents are re­ceiving as many as 50 offers for employ­ment today,” he said.

To illustrate the point, Dr. Williams showed a recent classified ad in the New England Journal of Medicine offering a starting base salary of $600,000 for an or­thopedic surgeon in coastal Georgia plus a sign-on and relocation bonus, full ben­efits, and a high-yield bonus. This is nearly double the median starting salary of $370,000 for an orthopedic surgeon identified in a recent Cejka Executive Search survey, he pointed out.

Median starting salaries for the seven surgical specialties studied ranged from a low of $260,000 for a general surgeon to a high of $450,000 for a neurosurgeon in the Cejka survey.

Invited discussant Dr. Nathaniel Sop­er, «facs»chair of the department of surgery at Northwestern University in Chicago, said, “It may end up being ultimately that these bidding wars are good for general surgeons, but I think it’s not going to be good for the population we serve, as there is going to be a shortage unless something is done.”

Dr. Sober suggested that the basic problem is not so much the division be­tween rural vs. urban, but the supply of surgeons, and asked what can be done to meet the estimated shortfall. He also questioned the model’s assumption that the population would remain equal in rural and urban areas.

Co-author and colleague Dr. Bhag­wan Satiani replied that the analysis in­cluded a simplified version of the federal model used to calculate supply and de­mand, but added that every projection in the last 50-75 years has been wrong. “You have to look at this model and say, ‘This is the best we can do right now,” he said.

According to Dr. Satiani, one of the best ways to increase the rural surgeon supply is through a comprehensive med­ical school rural program (MSRP). “If you took 10 medical students out of the class and put them into the MSRP pro­
gram, you could double the number of rural surgeons. That’s how important that is,” said Dr. Satiani, «facs»medical director of the vascular surgery laboratory and a professor of clinical surgery at Ohio State University.

A recently published report from the Physician Shortage Area Program (PSAP) at Jefferson Medical College in Philadelphia pro­vides a similar cal­culation for rural physicians and re­ports that 79%-87% of graduates from the two MSRPs with long-range rural out­comes – the PSAP and University of Minnesota at Duluth – remained in rur­al practice for up to 20 years (Acad. Med. 2011;86:272). It also notes that the Af­fordable Care Act authorized a new Rur­al Physician Training Grants program to provide grants to medical schools to de­velop or expand MSRPs.

Only 25 of the roughly 250 medical schools have general surgery programs, and just 10% of these could be consid­ered programs that attract rural sur­geons, according to Dr. Satiani. “I think American surgery is going to have to give this a separate tract within residency programs.”

Audience member Dr. Mark Malan­goni, «facs»associate executive director of the American Board of Surgery in Philadel­phia, pointed out that in such rural areas as Wyoming, the closest medical school is more than 1,000 miles away in Wash­ington state.

He suggested that one way to link rural hospitals and to counteract the professional isolation experienced by some rural physicians is through Web-based surgeon-to-surgeon consultations, an idea strongly supported by a recent survey of American College of Surgeons fellows.

If a new medical school were located in a rural area, Dr. Satiani said it could feed two to three nearby states, but not one of the new medical schools built in the last 5 years has been in truly rural ar­eas.

Finally, several audience members sug­gested that efforts need to be made to eliminate the perception among resi­dents that surgical specialists are some­how better than general surgeons.

“It’s the one-on-one thing that’s going to work with the residents, because all they see are these super-specialists,” Dr. Satiani said. “I think it has to come from the programs and the leadership; defin­ing general surgery better, even going as far as changing the name, if that be­comes an important issue.”

When asked in an interview what that new name might be, Dr. Satiani said the terms “master surgeon” and “omni sur­geon” have been floated, with master surgeon more likely to resonate with the general public.

I have checked the following facts in my story: (Please initial each.)

The authors reported no conflicts of interest. 

DETROIT – Rural hospitals will need to devise unique strategies to enhance hiring and retention in the face of a looming shortage of almost 30,000 sur­geons over the next 20 years.

“We think this shortage will result in competition between urban and rural hospitals, maybe perpetuating in bid­ding wars,” Dr. Thomas E. Williams Jr. said at the annual meeting of the Central Surgical Association.

“In a sense, this shortage could be a perfect storm; an imperative for both the urban and rural hospitals we see in America today.”

The researchers previously reported that an estimated 101,838 surgeons will need to be trained by 2030 to address a projected shortage in the United States of 29,138 surgeons in seven surgical spe­cialties: obstetrics and gynecology, or­thopedic surgery, general surgery, otolaryngology, urology, neurosurgery,
and thoracic surgery (Ann. Surg. 2009;250:590-7). I’ve searched and can’t find the print reference. Help?—EW The trick is to search by the article name in Google. I got abut 5 different versions that way./CNW»

The current analysis went one step fur­ther, focusing on the average recruit­ment needs for the seven specialties in rural vs. urban hospitals in light of the projected U.S. population of 364 million by 2030. The model assumed that there will be equal population growth in urban and rural areas; that rural hospitals will need to recruit obstetric/gynecologic, orthopedic, and general surgeons; and that the percentage of the population re­ceiving care at urban and rural hospitals will remain constant, Dr. Williams ex­plained.

Currently, the American Hospital As­sociation estimates that there are 3,012 urban hospitals in the United States. serving 82% of the population or 253 million Americans, and 1,998 rural hos­pitals serving 18% or 56 million Ameri­cans.

Based on these assumptions, the total number of surgical hires over the next 19 years will be 83,507 for urban hospitals and 13,953 for rural hospitals. This means urban hospitals must hire and re­tain 4,175 surgeons per year or 27.7 sur­geons per hospital, while rural hospitals will need to hire 698 surgeons per year or 7 surgeons per hospital, said Dr. Williams «not facs»of the department of surgery at Ohio State University in Columbus.

While the recruitment goals for urban hospitals might appear more daunting, rural hospitals are already facing a dra­matic loss of general surgeons.

“In rural hospitals, general surgery is essential,” he said. “[General surgeons] account for 60% of the revenue. What’s happening now is that about 34% of general surgeons are notifying their ad­ministrators of retiring or leaving in 2 years. Thirty-three percent of rural hos­pitals are recruiting now.”

Factors that might make rural re­cruitment more difficult include profes­sional and social isolation, cross coverage, insufficient training for the va­riety of procedures performed and pathologies encountered, and women’s preference for urban areas, he said.

Factors that positively influence rural recruitment include the chance to be a critical part of the community, indepen­dence, the wide spectrum of procedures, and hailing from a rural area.

One strategy that can tip a surgeon to­ward a rural hospital is doing a residen­cy in a rural training program. The researchers estimate that half of gener­al surgery residents who rotate through such a program will go on to practice in rural towns.

“It’s to the advantage of rural hospital administrators to establish rotations with medical schools in their hospitals, so they can have the opportunity to recruit some of the people that rotate through their rural hospitals,” Dr. Williams said.

Consideration of the needs of the sur­geon’s family is another factor. Typical­
ly, this will be a two-income family that values education and will need either good public schools or the means to pay for private schools. Most couples will also have educational debts, some as high as $400,000 for a two-physician cou­ple. Thus, educational loan repayment could be a potential “trump card” for rur­al hospitals in the future, he said.

Rural hospitals are already throw­ing out the wel­come mat. Most offer hiring incen­tives such as a re­location allowance; signing bonus; health, dis­ability, and life in­surance; and malpractice coverage. Educational loan forgiveness was offered by 38% of hos­pitals last year, up 7% from 2009, Dr. Williams said. Still, competition for new hires is fierce.

“In many general surgery programs in the United States, senior residents are re­ceiving as many as 50 offers for employ­ment today,” he said.

To illustrate the point, Dr. Williams showed a recent classified ad in the New England Journal of Medicine offering a starting base salary of $600,000 for an or­thopedic surgeon in coastal Georgia plus a sign-on and relocation bonus, full ben­efits, and a high-yield bonus. This is nearly double the median starting salary of $370,000 for an orthopedic surgeon identified in a recent Cejka Executive Search survey, he pointed out.

Median starting salaries for the seven surgical specialties studied ranged from a low of $260,000 for a general surgeon to a high of $450,000 for a neurosurgeon in the Cejka survey.

Invited discussant Dr. Nathaniel Sop­er, «facs»chair of the department of surgery at Northwestern University in Chicago, said, “It may end up being ultimately that these bidding wars are good for general surgeons, but I think it’s not going to be good for the population we serve, as there is going to be a shortage unless something is done.”

Dr. Sober suggested that the basic problem is not so much the division be­tween rural vs. urban, but the supply of surgeons, and asked what can be done to meet the estimated shortfall. He also questioned the model’s assumption that the population would remain equal in rural and urban areas.

Co-author and colleague Dr. Bhag­wan Satiani replied that the analysis in­cluded a simplified version of the federal model used to calculate supply and de­mand, but added that every projection in the last 50-75 years has been wrong. “You have to look at this model and say, ‘This is the best we can do right now,” he said.

According to Dr. Satiani, one of the best ways to increase the rural surgeon supply is through a comprehensive med­ical school rural program (MSRP). “If you took 10 medical students out of the class and put them into the MSRP pro­
gram, you could double the number of rural surgeons. That’s how important that is,” said Dr. Satiani, «facs»medical director of the vascular surgery laboratory and a professor of clinical surgery at Ohio State University.

A recently published report from the Physician Shortage Area Program (PSAP) at Jefferson Medical College in Philadelphia pro­vides a similar cal­culation for rural physicians and re­ports that 79%-87% of graduates from the two MSRPs with long-range rural out­comes – the PSAP and University of Minnesota at Duluth – remained in rur­al practice for up to 20 years (Acad. Med. 2011;86:272). It also notes that the Af­fordable Care Act authorized a new Rur­al Physician Training Grants program to provide grants to medical schools to de­velop or expand MSRPs.

Only 25 of the roughly 250 medical schools have general surgery programs, and just 10% of these could be consid­ered programs that attract rural sur­geons, according to Dr. Satiani. “I think American surgery is going to have to give this a separate tract within residency programs.”

Audience member Dr. Mark Malan­goni, «facs»associate executive director of the American Board of Surgery in Philadel­phia, pointed out that in such rural areas as Wyoming, the closest medical school is more than 1,000 miles away in Wash­ington state.

He suggested that one way to link rural hospitals and to counteract the professional isolation experienced by some rural physicians is through Web-based surgeon-to-surgeon consultations, an idea strongly supported by a recent survey of American College of Surgeons fellows.

If a new medical school were located in a rural area, Dr. Satiani said it could feed two to three nearby states, but not one of the new medical schools built in the last 5 years has been in truly rural ar­eas.

Finally, several audience members sug­gested that efforts need to be made to eliminate the perception among resi­dents that surgical specialists are some­how better than general surgeons.

“It’s the one-on-one thing that’s going to work with the residents, because all they see are these super-specialists,” Dr. Satiani said. “I think it has to come from the programs and the leadership; defin­ing general surgery better, even going as far as changing the name, if that be­comes an important issue.”

When asked in an interview what that new name might be, Dr. Satiani said the terms “master surgeon” and “omni sur­geon” have been floated, with master surgeon more likely to resonate with the general public.

I have checked the following facts in my story: (Please initial each.)

The authors reported no conflicts of interest. 

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

SAN FRANCISCO – Endo­scopic resection may help man­agement of clinically node– negative superficial squamous cell carcinoma of the esophagus, new data from Japan suggest.

<[stk -1]>A retrospective study of 83 patients who had endoscopic re­section and subsequent treat­ment because of the depth of cancer invasion found a 5-year survival rate of 76% when fol­lowed by chemoradiation and 100% when followed by surgery.<[etk]>

<[stk -1]>The most common complica­tion of the endoscopic resection was stenosis, noted in 11% of cases overall, lead investigator Dr. Toshiro Iizuka, a gastroen­terologist at Toranomon Hospi­tal in Tokyo, reported at the meeting  on gastrointestinal can­cers sponsored by the American Society of Clinical Oncology.

“Endoscopic therapy plus ad­ditional treatment for M3 to SM2 superficial carcinoma of the esophagus did not entail the development of any serious complications. Thus, such com­bined treatment was safe and feasible,” Dr. Iizuka comment­ed. “The long-term follow-up results were fairly gratifying.”

“Surgical resection has been considered as a standard treat­ment in cases of superficial esophageal cancer with poten­tial lymph node metastasis,” but up to two-thirds of patients ex­perience serious complications.

<[stk -1]>“The frequency of lymph node metastases in superficial squamous cell carcinoma of the esophagus … depends on the depth of invasion,” said Dr. Iizu­ka. “Accordingly, a therapeutic strategy has become feasible whereby endoscopic submucos­al dissection aimed at local con­trol is undertaken first, followed by considering additional treat­ment based on the results of the histological examination.”<[etk]>

<[stk -1]>The patients all had T1 tu­mors and clinically node-nega­tive (cN0) status as determined by endoscopy, endoscopic ultra­sound, CT, and PET imaging. They had endoscopic resection, either endoscopic mucosal re­section (EMR) before March 2005 or endoscopic submucosal dissection (ESD) after.<[etk]>

<[stk -3]>Histologic evaluation of the endoscopically resected lesions showed that 140 patients had pathologic M3, SM1, or SM2 tu­mors, and they therefore received additional treatment. Patients found to have pathologic M1 or M2 tumors were followed.<[etk]>

Dr. Iizuka focused on results for 27 patients who underwent subsequent surgical resection and 56 who underwent subse­quent chemoradiation, with the choice between these two op­tions left to patients after dis­cussion of each in their case.

Overall, these patients had a mean age of about 63 years, and 87% were men. Tumors were roughly equally located in the upper, middle, and lower esophagus; the mean size was 42 mm in the surgery group and 26 mm in the chemoradia­tion group. The majority of en­doscopic resections were ESD.

In the surgery group, patients more often had a three-field lymph node dissection (59%) than a two-field one (41%). In the chemoradiation group, the majority of patients received 40-45 Gy of radiation (86%) and low-dose 5-fluorouracil and cis­platin chemotherapy (57%).

Results for all 140 patients who underwent endoscopic re­section showed a resection rate of 81% and an R0 resection rate of 72%. Overall, 15% of pa­tients had a complication from the procedure, with stenosis, at 11%, being the most common.

The main complications were anastomotic stenosis (15% of patients) and recurrent nerve palsy (7%). Also, 7% of patients were found to have residual can­cer and 4% were found to have lymph node metastases. The main serious complication of chemoradiation was grade 3 leukopenia (14%). There were no treatment-related deaths or grade 4 adverse events.

The median duration of fol­low-up was 42.5 months in the surgery group and 33 months in the chemoradiation group.

None of the patients had a lo­cal recurrence. The actuarial 5-year rates of relapse-free survival were 100% and 88%, re­spectively; the actuarial 5-year rates of overall survival were 100% and 76%, respectively.

Dr. Iizuka reported no rele­vant conflicts of interest.

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Gunnar Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

      drug names and dosages -

      lab test values and their units -

      whether nos. are correct and add up, and whether percentages based on those nos. are correct -

      citation (e.g., JAMA 2008;299:785-92) -

      investigators’ names and affiliations -

      all other proper names (e.g., clinical trials; geographic, company, and test names) –..

      investigators' conflicts of interest and sponsor of study – 

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Gunnar Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

      drug names and dosages -

      lab test values and their units -

      whether nos. are correct and add up, and whether percentages based on those nos. are correct -

      citation (e.g., JAMA 2008;299:785-92) -

      investigators’ names and affiliations -

      all other proper names (e.g., clinical trials; geographic, company, and test names) –..

      investigators' conflicts of interest and sponsor of study – 

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”

Note: The definitions of ‘first’ and ‘success­ful’ can be contentious in any branch of his­tory.The history of medicine is no exception. The dates and events listed below have at least some legitimate consensus behind them.

1893 First documented successful peri­cardium repair (Daniel Hale Williams)

1896 First successful heart operation (Ludwig Rehn).

1924 First successful pulmonary em­bolectomy (Martin Kirshner).

1937 Congenital heart surgery ‘begins’ with ductus ligation procedure (John Streider).

1938 First ductus ligation leading to full recovery (Robert Gross).

1945 Blalock-Taussig operation for ‘blue baby syndrome’ (Alfred Blalock/Helen Taussig).

1946 First anomalous coronary artery re­pair (Gunnar Biorck/Clarence Crafoord).

1947 First successful pulmonary valvo­tomy (Thomas Holmes Sellers).

1948 First successful mitral commis­surotomy (Charles Bailey).

1952 First successful right-sided heart bypass (Forest Dodrill).

1953 First complete atrioventricular canal using cross-circulation (C. Walton Lillehei).

1954 First Tetralogy of Fallot repair us­ing cardiopulmonary bypass (John Kirklin).

1962 First pulmonary embolectomy us­ing cardiopulmonary bypass (Edward Sharp).

1968 First successful cardiac arrhythmia surgery (Will C. Sealy).

I have checked the following facts in my story: (Please initial each.)

      drug names and dosages -

      lab test values and their units -

      whether nos. are correct and add up, and whether percentages based on those nos. are correct -

      citation (e.g., JAMA 2008;299:785-92) -

      investigators’ names and affiliations -

      all other proper names (e.g., clinical trials; geographic, company, and test names) –..

      investigators' conflicts of interest and sponsor of study – 

Compiled from the following source:

“History of Cardiac Surgery,” Larry W. Stephenson, in Lawrence H. Cohn, (ed) <[lb]>“Cardiac Surgery in the Adult.”