An Interview with Dr. John L. Cameron, the Hall of Famer of Pancreatic Cancer.

The Society of Surgical Alimentary Tract (SSAT) Resident Education Committee aim is to facilitate resident participation in the annual meeting and foster the education of the next generation of gastrointestinal. The SSAT "Residents Corner" was developed as a video-blog highlighting areas of interest for surgical trainees looking to focus on a career in gastrointestinal surgery. The topics covered are to make surgical education more accessible, one way is to highlight leaders in the field who discuss their journey. A 10-min video of a surgical mentor is recorded and archived on the SSAT site under a video series called "Mentor of the Month." A synopsis of a video published online February 2018 featuring Dr. John Cameron interviewed by one of his trainee, Dr. Vanita Ahuja. Dr. Cameron shares his thoughts on his accomplishments, challenges, and advice for young surgeons and the future of pancreatic surgery. The interview offers an insight into the mind of one of the greatest leaders of surgery of our time.

John L. Cameron, MD: Overview of His Career.

: Introduction to the John Cameron Festschrift.

Inicios de la cirugía pancreática oncológica en España. Un tributo a los pioneros / The origins of oncological pancreatic surgery in Spain. A tribute to pioneers

La duodenopancreatectomía cefálica (DPC) es una intervención quirúrgica muy compleja cuyo desarrollo tuvo lugar de forma muy lenta y en los centros de mayor prestigio del mundo. El objetivo de esta investigación es conocer quiénes fueron los cirujanos que realizaron las primeras DPC en España y las circunstancias en que se realizaron. En un contexto histórico caracterizado por la gran escasez de medios técnicos y económicos, como era España en los años 50 del siglo XX, las primeras DPC se llevan a cabo en Barcelona, en el Hospital de la Santa Creu i Sant Pau, donde se desarrolló una escuela de cirugía gastrointestinal liderada por cirujanos que se convirtieron en la punta de lanza de la cirugía española y referencias nacionales como fueron Pi-Figueras, Vicente Artigas, Soler-Roig y Antonio Llauradó. Casi de forma simultánea, en Oviedo, Luis Estrada introdujo también la DPC y la duodenopancreatectomía total tras un periodo de formación con los pioneros de la cirugía pancreática en Estados Unidos

Pancreaticoduodenectomy (PD) is a very complex operation. Its development took place very slowly at the most prestigious centers in the world. The aim of this investigation is to know who were the first surgeons to perform a PD in Spain as well as its historical circumstances. Despite all kinds of difficulties and very few resources, the first PD in Spain were carried out in Barcelona at the Hospital de la Santa Creu i Sant Pau where from the mid-50s a school of gastrointestinal surgery emerged with surgeons soon to become the spearhead of the Spanish surgery and a reference for the whole country: Pi-Figueras, Vicente Artigas, Antonio Soler-Roig and Antonio Llauradó. Almost simultaneously, in Oviedo, Luis Estrada also introduced the PD and total pancreaticoduodenectomy after a period of training with the pioneers of pancreatic surgery in the United States

The origins of oncological pancreatic surgery in Spain. A tribute to pioneers. / Inicios de la cirugía pancreática oncológica en España. Un tributo a los pioneros.

Pancreaticoduodenectomy (PD) is a very complex operation. Its development took place very slowly at the most prestigious centers in the world. The aim of this investigation is to know who were the first surgeons to perform a PD in Spain as well as its historical circumstances. Despite all kinds of difficulties and very few resources, the first PD in Spain were carried out in Barcelona at the Hospital de la Santa Creu i Sant Pau where from the mid-50s a school of gastrointestinal surgery emerged with surgeons soon to become the spearhead of the Spanish surgery and a reference for the whole country: Pi-Figueras, Vicente Artigas, Antonio Soler-Roig and Antonio Llauradó. Almost simultaneously, in Oviedo, Luis Estrada also introduced the PD and total pancreaticoduodenectomy after a period of training with the pioneers of pancreatic surgery in the United States.

Evolution of the Whipple procedure at the Massachusetts General Hospital.

BACKGROUND: Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). METHODS: We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. RESULTS: The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). CONCLUSION: The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.

History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers.

Pancreaticoduodenectomy is one of the most challenging surgical procedures which requires the highest level of surgical expertise. This procedure has constantly evolved over the years through the meticulous efforts of a number of surgeons before reaching its current state. This review navigates through some of the early limitations and misconceptions and highlights the initial milestones which laid the foundation of this procedure. The current review also provides a few excerpts from the lives and illuminates on some of the seminal contributions of the three great surgeons: William Stewart Halsted, Walther Carl Eduard Kausch and Allen Oldfather Whipple. These surgeons pioneered the nascent stages of this procedure and paved the way for the modern day pancreaticoduodenectomy.

[Evolution of the treatment of pancreatic cancer]. / Wandel in der Therapie des Pankreaskarzinoms.

Cancer of the pancreas was not diagnosed until the nineteenth century, and the first surgical attempts were not carried out until the end of that century, and then only within the framework of local tumour removal. Already in 1898, however, Codivilla described the operative method that is today considered the standard operation and which, in the form of partial duodenopancreatectomy, is the most commonly performed procedure on the pancreas. Evolutionary change in this area represents nothing more than the gradual introduction of minor modifications which, however, had no impact on the " heart" of the surgical approach. The particular feature of surgical treatment of pancreatic cancer--since 1935 known as Whipple's procedure--is the considerable length of time of 80 years that it took before it finally found widespread acceptance. Further several decades passed until, by the end of the 20th century, recognizable successes were reported, for example, a resection rate of 30%, a hospital mortality rate of less than 5% in specialized centers, and a reported 5-year survival rate varying from 1% to 20%. Even after the last 100 years of slow evolution, surgeons have by no means conquered cancer of the pancreas, and the low 5-year survival rates, together with the recurrences and late metastases prompted Trede in the year 2002 to remark: "we have to conclude that surgery alone cannot cure pancreatic carcinoma".

History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique.

The history of pancreaticojejunostomy in pancreaticoduodenectomy is described. Many types of operations have been devised in search of a more reliable method of anastomosis. To perform a safe and reliable pancreaticoenteric anastomosis it is necessary to understand the organ characteristics of the pancreas. We investigated factors required for a reliable pancreaticojejunostomy and devised a new surgical technique that meets those requirements. We introduce the theoretical substantiation and clinical usefulness of our new surgical technique while reviewing the history of pancreaticojejunostomy after pancreaticoduodenectomy. The unique aspect of our method is approximation of the pancreas stump and jejunal wall by six to eight interrupted sutures. It is speculated that too many sutures and tying too tight in the anastomosis may cause ischemia and necrosis of the pancreatic stump by restricting the tissue blood flow. Our method allows us not only to reduce the number of sutures, but also to avoid some of the complicated manipulations done in any other existing methods. The newly devised pancreaticojejunostomy is an excellent surgical technique with anastomotic failure seen in only two patients and no deaths out of 162 consecutive patients.

[Walther Kausch (1867-1928) and his significance in pancreatic surgery]. / Walther Kausch (1867-1928) und seine Bedeutung für die Pankreaschirurgie.

The very interesting medical career of Walther Kausch, student of Johannes Mikulicz-Radecki, is portrayed. The first successful partial pancreatoduodenectomy of the world in 1909 was his great surgical feat. The question why Kausch did not go on this promising way will be discussed. In future it would be appropriate to speak of the "Kausch-Whipple-Operation".