Dr. Rajendra Toprani
Indian Association of Surgical Oncology
Subject: A report on Detroit visiting fellowship of IASO 2015 availed at Detroit Medical Centre
(DMC), Detroit under mentorship of Prof. Donald Weaver from May 24th to June 25th, 2017.
I was awarded IASO-Detroit vising fellowship in the year 2015, which due to several reasons could not be availed last year. As the leadership of IASO and the past fellowship alumni intervened proactively and sorted out the issues with the host Prof. Donald Weaver last year at NATCON, IASO, jodhpur, I could avail the fellowship this year. I am extremely grateful to the IASO and Prof. Weaver for
the same. During NATCON-IASO 2016 at Jodhpur, When I approached Prof. Donald Weaver, he was more than willing to share his contact details and guided me all along. I could communicate with his personal secretary Mrs. Janet Damm and complete all the preliminary paper work and clearances including an online course well in advance.
When I arrived in Detroit on May 23rd, Prof. Weaver through his secretary had arranged for my accommodation and I did not find any difficulty in settling quickly. During first week of my visit as per the hospital policy I went through various clearances including security and occupational health check screening. I was enquired about my immunization status and TB Screening. There was an orientation
program for all fresh employees and volunteers which dealt with the core values of the organization and expected behavior of the new comers. After all the clearances, I was issued a identity card cum access pass and I was ready to go through the observation schedule. The weekly schedule included surgeries on Monday, Tuesday and Thursday, endoscopies on Wednesday morning and outpatient clinic on Friday and Wednesday afternoon. On Wednesdays, there was a departmental seminar and Mortality and morbidity meet in the morning.
DMC Harper University Hospital, host the department of Surgical Oncology which is located on the 4th floor. The operation theatres are in the basement and outpatient clinics are in the 5th floor of the hospital. In the outpatient clinic, I could observe the ways Prof. Weaver interacts with his patients. It was totally a different experience for me compared to the outpatient services back in my home Institute. I could get a glimpse of the patient appointment system, evaluation process and scheduling of surgery. I saw several patients treated for pancreatic neuroendocrine tumors, colorectal malignancies and post whipples resection for pancreatic ductal adenocarniomas. I also some patients on long term follow up being treated in the past for secondaries in liver.
During the month of my visit though the total number of cases operated were less, I could observe some of the surgeries like laproscopic ventral hernia repair, laparoscopic staging and liver lesion biopsy for a colorectal cancer, laproscopic diversion colostomy, open subtotal colectomy, open anterior resection with ileal J pouch anal anastomosis, liver resections etc. Professor Weaver also introduced me to several of his surgical colleagues so that I could watch some of the thoracic surgeries as well.
During the weekend, I could visit some of my friends near Detroit and take a tour of East Coast with my family. Overall this experience was unique and very much useful to enhance my clinical and operative acumen. In the end I wish to convey my gratitude to the IASO, Prof. Donald Weaver and the selection panel for the fellowship Prof. Vijaykumar M, Dr. TS Rao, Dr. DD Patel, Dr. Chandrakanth Are and Dr. Topranibhai, the present secretary IASO for providing me an opportunity to visit DMC, Detroit.
Dr. Narendra H
Department of Surgical Oncology
Sri Venkateswara Institute of Medical Sciences
Tirupati, AP 517507
SSO – IASO International Career Development Exchange Award 2017 – Report
Dr. KAILASH RAMRAO SURNARE M.S., M.Ch.
Department of Surgical Oncology
Prince Aly Khan Hospital
Mumbai , India
I thank the Indian Association of Surgical Oncology (IASO) and the Society of Surgical Oncology (SSO) for selecting me as the IASO-SSO International Career Development Exchange (ICDE) Award recipient for the year 2017. I would like to thank my teacher and mentor Prof. B.K.C Mohan Prasad (President, IASO), Prof. Daniel G Coit (President, SSO), Prof. Dhairyasheel Sawant (Vise-president IASO), Prof Rajendra Toprani (Secreatory IASO) Dr. T. Subramanyeshwar Rao and my mentors Dr. J. Joshua Smith Dr J Garcia Aguilar and Dr Laleh Melstrom for their support and guidance throughout the visit. I also thank Ms. Ana Olivares (Manger ,Global Outreach & special programs) and Ms. Becky Williams ,Ms. Eileen Widmar of the SSO Office for arranging and organizing my visit and helping me during the visit.
My visit to the USA during the ICDE program consisted of 2 parts.
- SSO Annual Symposium
- Institution visits
SSO Annual Symposium
The 70th SSO Annual Cancer Symposium was held from March 15th to 18th, 2017 at the Washington Convention Center in Seattle, WA in which more than 1500 attendees participated. The symposium began on 15th March with pre-conference workshops on minimally invasive surgery for colorectal cancer and Timely topic in clinical research and Tips for success. The SSO International Reception was hosted by Dr Daniel G Coit, the President of SSO on the evening of 15th to welcome the ICDE 2017 awardees from 7 societies (India, Brazil, Japan, Chinese ,Canada,Korean and Europe) from all around the world including myself were cordially welcomed and introduced to our respective mentors and various SSO executives and members.
The conference proper began on the next day and divided into various tracks on GI/HPB, colorectal, melanoma and sarcoma, breast, general education and others. On the first day, I attended the case presentation with professors and fellows, breast and colorectal parallel sessions, session on Precision delivery of RAS-inhibiting siRNA to pancreatic cancer via Peptide based Nanoparticle by Matthew Strand
and the session on current controversies in neoadjuvant therapy for locally advanced breast cancer.
The Exhibit hall for Posters, the Residents and Fellows lounge and Exhibit hall for the corporate sponsors were well organized. The posters on all three days were of good quality. Basic science ad translational research were the topics of a substantial number of these. There were posters from many other countries including a few from India. The video sessions were very useful and showed some of the latest technologies available. The mobile app for the symposium and SSO 2017 Virtual meeting available online were very useful to organize ourselves and view sessions that we missed out during the day. The meeting also included “Meet the Professor” Breakfast sessions and some sponsored sessions on all days which I could not attend.
The plenary sessions, the James Ewing Lecture by Dr. Jedd D Wolchok on “Immunologic checkpoint blockade : Exploring combinations and mechanisms” and John Wayne Clinical research Lecture by Dr Lorenzo Ferri on “postoperative complications and cancer Recurrence:Dissecting the role of neutrophils in the metastatic process”. Challenges in bringing new technologies to the operating room symposium was good.
The second day, Distinguished Service Award was presented to Prof. Fabrizio Michelassi and SSO presidential address “Charting the course ahead for the society of surgical oncology: The future Isn’t What it used to be”. The Video session on Robotic distal subtotal gastrectomy with D2 lymphadenectomy for advanced gastric cancer and laparoscopic gastric adenocarcinoma. The afternoon included a Great Debates Session and Parallel sessions of oral presentations of original papers, evidence based approach to management of locally advanced rectal cancer. I also attended the SSO-IASO Meeting on future cooperation between the two societies and the President’s Private Dinner Reception.
The third and final day included Clinical and young Investigator award papers, American cancer society /SSO basic science lecture on Obesity,white adipose inflammation and breast cancer by Dr Andrew J Dannenberg , great debates in breast cancer, top rated videos session, case presentations with professors and fellows and other parallel paper sessions. The meeting ended with a President’s Reception.
My goal in attending the SSO annual cancer symposium was to know the differences, if any in the practice of surgical oncology between USA and India and keep abreast with the latest technological developments and research going on in the west. I hope that this visit would stimulate me in doing better research and help refine my practice.
I visited two cancer centers as part of the ICDE Program.
1. Memorial Sloan Kettering Cancer Center, New York – Dept. of Colorectal Surgical Oncology
Dates: 20th March to 24rd April 2017
Mentor:Assistant Prof. J. Joshua Smith
I visited the colorectal Surgical Oncology Department at MSKCC . My mentor was Dr J Joshua Smith , Assistant Professor of Surgical Oncology at MSKCC . Ms. Tracey and Mr. James, his assistant had prepared a good and compact schedule for the visit.
Day 1 in the morning I have attended Surgical oncology fellows teaching conference on surgical management of colorectal liver metastasis ,Surgery grant rounds Remodeling the remodelers :Targeting Mammalian SWI/SNF complexes in Human cancer by C Kadoch in Mortimer B Zuckerman Research Canter (ZRC).A tour of MSKCC by Mr. James, showed me High Tower including the ORs, Clinics,
Colorectal Radiology, the research library, etc. MSKCC prides in being the largest hospital complex in the world and is easy to get lost in it. However it is highly organized and has patient friendly transport systems all around. In the evening I attended the colorectal multidisciplinary meeting on SSI/ERAS and colorectal DMT cases along with other surgical oncology fellows.
I attended the ORs with Drs Garcia, Nash,Guillem and Smith . The ORs were located at the Main Building. The Robotic surgeries served included abdominoperineal resecton,right hemicolectomy ,Pelvic exentration,low anterior resection Tumor debulking,ileostomy closure. I had the opportunity to see extralavator APR surgery done by Dr Garcia .I was impressed by the patient safety “Time Out” practiced at MSKCC. I learnt about the current studies and trials underway at the MSKCC. Dr Smith my mentor showed his research animal models of mouse and how they were processing the various genetic tests on colorectal cancer resected specimens. He showed me his research presentation on role of prognostic gene mutation identification in treated cases of colorectal cancer patient with neoajuvant chemoradiation.It was very interesting. He discussed with me challenging case scenarios in practice like recurrent rectal cancer
management. I attend the colorectal cancer Clinic with Dr. Garcia and Dr Smith in Rockefeller Outpatient Pavillion . I observed and learnt how patients are worked up in a multidisciplinary approach involving the surgical oncologist, medical oncologist, radiation oncologist, colorectal radiologist, genetic counsellors, etc. and are encouraged to be part of some study or trial. Dr Smith gave me sufficient time for case discussions and took me for lunch also.
The overall experience at MSKCC was extremely positive and I hope to carry home at least some of the good practices at MSKCC and implement them into my practice. I thank Dr. Smith ,Dr Garcia and his colleagues for the experience I gained at MSKCC.
2. City Of Hope .Duarte CA – Hepatopanceratobiliary Dept. of Surgical Oncology
Dates: 27th March to 31st March 2017
Mentor:Assistant Prof.Laleh Melstrom
My next visit was to city of hope ,Duarte ,CA . My mentor at City Of Hope was Assistant Prof Laleh Melstrom. I had the opportunity to interact with another ICDE recipient from Japanese Society of gastrointestinal surgery Dr Takashi Mtisui from The University of Tokyo,Japan and discuss about medical care in his country. Assistant to Melstrom Ms Carolina was very cooperative, took me for a tour around the Hospital, Research Centers and handed over the ID badge of hospital. City Of hope campus was very huge with lot of things to see like Japanese garden, alternate therapy to patients music ,cancer survivor meetings. It has also Diabetology research center.
The five day visit was well organized by Dr.Melstrom to spend time in OR, Clinic, Wards and Research labs. On Monday, I met Prof Gagandeep Singh Chief hepatobiliary services and also met Dr Yanghee Woo academic coordinator then went to the OR orientation Helford Hospital. I attended GI tumor board (CRC) with Dr. Melstrom. In evening Dr Melstrom took me for Dinner, First we went to Dr Y Fong,Director of City Of Hope,house and she introduced me.
On the next day Tuesday ,I have attended OR with Drs Melstrom,Yanghee Woo,Kurt Melstrom,Lou,Mark Wakabayashi,Lee, I went to the OR and observed the cases.The robotic and open surgeries observed included heaptic metastatectomy for CRC metastasis,Pelvic exentration for recurrent rectal cancer,Radical hysterectomy.
On Wednesday ,I was in OR , observed robotic surgery low anterior resection, abdominoperineal resection. In the afternoon, I went to clinic with Dr Melstrom .
On Thursday I joined the surgical oncology ward rounds with the residents in the mornings. I observed surgery cytoreduction with HIPEC for colon cancer .I attended the GI tumor board, case discussions in which residents participated in the discussion on the management of some difficult cases.
On Friday I observed robotic distal gastrectomy done by Dr Y Woo. I enjoyed the stay at Duarte. The experience and atmosphere at Duarte was much different from that at MSKCC with a more personal touch. I was also able to get good vegetarian Indian food. Dr. Melstrom and I discussed about the options for future and agreed to stay in touch. The overall experience was great and most beneficial for me.
I have accomplished my objectives mentioned in personal statement. I have learned individual patient management based on evidence with tumor board discussion.I have observed the advanced robotic surgery in oncology.Advanced instrument were there in OR.I will apply this knowledge to improve my patient care .I will conduct lecture on update on colorectal cancer management and minimally invasive
surgical approach for my postgraduate residents also also I will share experience with my fellows.I will do discussion of as much as possible cases in the tumor board with medical and radiation oncologists.
Detroit visiting fellowship
Started by the efforts of Dr. K. K. Maudar, Bhopal and Dr. Donald Weaver, Detroit Medical Centre, Detroit in the year 2000. The fellowship is awarded to a young surgical oncologist from India and a member of IASO, on the basis of his curriculum vitae and presentation of paper on the original work done in India only. So far 10 fellowships have been awarded.
2000 – SVS Deo, Delhi
2001 – DR. Somesh Chandra, Ahamedabad
2002 – K A Pathak. Mumbai
2003 – Dr. Manoj Pandey, Trivandrum
2004 – None
2005 – Gajanan Wagholekar, Pune
2006 – Diptendra Sarkar, Kolkata (2008)
2007 – T B Yuvaraja, Mumbai (2009)
2008 – Dr. Suraj Manju Nath, Bangalore
2009 – Dr. A A Sonkar, Lucknow
2010 – Dr Atul Samaiya, Bhopal
2011 – Dr. Vinay Kumar, Varanasi
2012 – Dr. Sandeep P. Nayak, Bengaluru
IASO-Baroda – GCRI Minimal Invasive Surgery Travelling Fellowship
Started after the merger of GCRI and Baroda travelling fellowship in 2007. Earlier was given as Baroda fellowship started in 1999. This fellowship is awarded to a young member of IASO on the basis of presentation of paper in the award session and his curriculum vitae. The fellowship is availed at Gem Hospital, Coimbatore with Dr. C Palanivelu.
So far the followings have availed this fellowship
1999 – Dr. Rajendra Singh, Lucknow
2000 – None
2001 – none
2002 – none
2003 – Dr. Prafull Kumar Das, Cuttack
2004 – Dr. Pawan Gupta, New Delhi
2006 – Mithlendra Kumar,
2007 – Dr. Harish Sharma, Hisar
IASO-GCRI -Baroda MIS Fellowship
2008 – Dr. Chandramohan K, Trivandrum
2009 – Dr. Sanjeev Prashad, Rohtak
2010 – None
2011 – Dr. Rajshekhar C Jaka, Bangalore
2012 – Dr. Narendra hulikal, Tirupati
Started in the year 2010 with the help of British Association of Surgical Oncology and the corpus from the joint meeting of IASO-BASO held in Hyderabad in 2008, this fellowship is awarded to a young surgical oncologist from India based on the interview with BASO-IASO executives and paper presentation.
The first fellowship has been awarded this year to Dr. K Chandramohan, Trivandrum to be availed in 2011.
2011 – Dr. Chandramohan K, Trivandrum
2012 – Dr. Ashutosh Chauhan, Lucknow