IGS reports on journey through the halls of U.S. surgical research

The International Guest Scholar (IGS) program of the American College of Surgeons (ACS) has a renowned and well-established reputation, and for many years young academic researchers worldwide have dreamed of being selected as recipients of this award. I cannot describe my feelings when I found out that I was the recipient of such a distinguished honor—obtained in Italy only by four eminent colleagues before me since 1968. It was the start of a fantastic new adventure, and I could not imagine anything more exciting as a young academic physician.

Clinical Congress 2016

The first stop on my trip was the ACS Clinical Congress 2016 in Washington, DC. Starting with the Presidential Address delivered by then-ACS President Courtney M. Townsend, Jr., MD, FACS, during Convocation, we scholars were welcomed to perhaps the most important scientific event of the year related to surgical research. George Velmahos, MD, PhD, MSEd, FACS, then-Chair of the International Relations Committee, later told the IGS recipients, “The mere fact that you are here means that you represent the top of surgical research of your country and are a representative of the best researchers from all over the world.”

The Clinical Congress comprised several interesting scientific sessions, focused on a number of topics and themes, and provided exposure to surgical innovations and new technologies. But what was really exciting was the pleasant atmosphere of this event—having the opportunity to meet the most influential American surgeons and scientific authorities representing the tradition of American surgery. The breadth of the event, the quality of the scientific sessions, and the extraordinary variety of technology-based presentations were impressive. After the scientific session dedicated to ACS international scholars and travelers, I had the opportunity to introduce myself as a researcher in a public session and to meet many colleagues.

The friendly atmosphere also was fostered by both my fantastic mentors—Richard Schulick, MD, MBA, FACS, professor of surgery-surgical oncology, and chair, department of surgery, and Barish Edil, MD, FACS, professor and chief, surgical oncology, University of Colorado, Aurora. These colleagues, renowned for pancreatic surgery research achievements, were assigned to me as guides to understanding the American health care system and the organization of Clinical Congress, and to helping me make contact with the departments of surgery I was to visit while in the U.S. I want to thank both Dr. Schulick and Dr. Edil for their support and introductions.

The Clinical Congress was a fantastic scientific meeting and included a number of enjoyable social occasions, such as the President’s Dinner and a guided tour of Washington, DC, monuments illuminated at night.

Memorial Sloan Kettering

After the Clinical Congress, the first surgical center that I had the privilege of visiting was the Memorial Sloan Kettering Cancer Center (MSKCC) in New York, NY. My host at this institution was William Jarnagin, MD, FACS, chief, hepatopancreatobiliary service, and Benno C. Schmidt Chair in Surgical Oncology. This visit was of great interest to me because it mainly focused on the treatment of hepatobiliary tumors. I had the opportunity to learn about the staff’s multidisciplinary approach to liver tumors and their high level of competence in treating these diseases, as well as witness Dr. Jarnagin’s approach to patient care. I also had the opportunity to observe the center’s operating room, protocols, and physical resources. All of the surgeons on the hepatobiliary and pancreatic teams are very talented, and I had the good fortune to observe them during many operations.

One of the most interesting aspects of my visit to MSKCC was the chance to see how the cancer care team uses neoadjuvant chemotherapy through the gastroduodenal artery catheter to treat many different liver tumors. I could verify directly the high success rate of this approach, allowing, in many cases, an impressive reduction of tumor load.

Massachusetts General Hospital

My scientific journey continued with a one-week visit to Massachusetts General Hospital, Boston, where I had the privilege of meeting Keith Lillemoe, MD, FACS, surgeon-in-chief and chief, department of surgery, and his staff. Dr. Lillemoe’s group is mainly focused on pancreatic surgery. As one of the leading groups on pancreatic surgery in the U.S. and around the world, I appreciated the multidisciplinary approach used to treat pancreatic neoplasms, together with the quality of laparoscopic surgical care. Thanks to Dr. Lillemoe’s welcome and the warm hospitality of the entire group, I was invited to give a lecture to the medical faculty, which focused on the history and future of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure. The audience had many questions, and it was a pleasure to discuss rising concerns and new ideas on this topic in such an eminent academic environment. It was a pleasant surprise to find a liver group in the U.S. that was very advanced on the topic of ALPPS and performs many of these procedures.

During the week in Boston, I had the opportunity to become acquainted with the impressively detailed organization of Massachusetts General combined with the high standard of quality care. I took part in interdisciplinary meetings and scientific sessions focused on pancreatic diseases, but they also personally interacted with and interviewed many colleagues. A scientific cooperation on a project started from an idea during one of those interviews and is still ongoing, and we are working together with the surgical group of Dr. Velmahos, who is chief, division of trauma, emergency surgery, and surgical critical care.

MD Anderson Cancer Center

Dulcis in fundo [last but not least], my scholarship ended with one week in Houston, TX, visiting the University of Texas MD Anderson Cancer Center, in particular the group led by Jean-Nicolas Vauthey, MD, FACS, chief, hepato-pancreato-biliary (HPB) section, Bessie McGoldrick Professor in Clinical Cancer Research, and professor, department of surgical oncology, division of surgery. I could not imagine a more satisfying experience for a surgeon like me, with scientific interests focused on liver surgery. I was impressed by the scale and impact of the entire Texas Medical Center, with its 100,000 employees and its status as a center of excellence for oncologic treatment.

Dr. Vauthey personally examined several neoplastic patients during the day, and I had the pleasure of accompanying him in his ambulatory consultant activity, tumor board conferences, and, of course, the operating room. While operating, Dr. Vauthey asked me stimulating questions, challenging my knowledge of the field of HPB surgery, anatomy, and physiology. This singular experience was really the biggest opportunity to test myself with a renowned American surgeon.

One evening, I was invited to a unique “scientific meeting” at Dr. Vauthey’s home. During the dinner meeting, Dr. Vauthey and his collaborators and I discussed many interesting topics and aspects of some recently published papers on HPB by Dr. Vauthey’s group. I was astonished by the high scientific level of the discussion, reevaluating particularly the positive use of neoadjuvant chemotherapy for advanced neoplastic liver patients, as well as the value of genetic profiles of tumors obtained through biopsy—concepts promoted and propagated by Dr. Vauthey in order to select candidates for surgery.

Epilogue

Coming back to Italy after my experience in the U.S. as an ACS International Guest Scholar, I felt that my knowledge had been greatly enriched. I have to thank, above all, my “master” and academic mentor, Prof. Francesco Basile, MD, director of the surgical clinic and rector of Catania University, who is the protagonist of my education and career and who allowed me to have this marvelous opportunity.

The award was not only a great honor, but also will open new doors for my career and education. Thanks to the wonderful opportunity given to me by the Board of Regents of the ACS, I was able to meet many renowned American colleagues and may be starting to build a scientific bridge between my university and Massachusetts General. Therefore, my application to become a Fellow of the ACS was the natural conclusion of such an amazing journey but, at the same time, a new start of an already exciting scientific life.

Acknowledgment

I want to offer a special thank you to Kate Early, International Liaison, ACS Division of Member Services, Chicago, IL, for her daily work and support of this program.