Hepato‐pancreato‐biliary and transplant surgery experience among New Zealand general surgery trainees

Abstract

Background Subspecialty surgery experience during general surgery training in Australasia is influenced by many factors, including duration of training, training location and the introduction of post‐fellowship training programmes. Experience in hepato‐pancreato‐biliary (HPB) and transplant surgery is part of the general surgery curriculum, although trainee experience in these subspecialties has not been quantified in this region, which is relevant to post‐fellowship training programmes. Therefore, the aim of this study was to quantify the HPB and transplant operative experience of New Zealand (NZ) general surgery trainees. Methods Operative logbook data were analysed for all NZ trainees from 2013 to 2017, including procedures categorized as pancreatic, biliary, hepatic and transplant surgery only. The number of cases within each category was used to model the cumulative operative experience over a 5‐year training programme. Results During the study period, 118 trainees (303 trainee years) recorded 15 662 HPB and transplant procedures. Of these, 13 838 (88.4%) were cholecystectomies (mean cumulative experience 219.3 cases). Excluding cholecystectomy, trainees had a mean cumulative experience of 5.7 biliary, 7.5 pancreatic, 8.1 liver and 4.2 transplant procedures during their training. Transplant experience was predominantly access for peritoneal dialysis (228/260, 86.7%), with cumulative transplant experience otherwise reaching 0.47 procedures over 5 years. Conclusion Exposure to HPB and transplant surgery during general surgery training in NZ is limited beyond cholecystectomy. Additional exposure during post‐fellowship training is likely required for general surgeons to practice in these subspecialties.

Natural Killer Cells for Cancer Immunotherapy: Opportunities and Challenges

“…For decades, effective implementation strategies have been developed to optimize the advancements in the fields of tumor survivorship, diagnosis, treatment, and end-of-life care [10]. For instance, a series of treatments have been developed to conquer cancers with high uncontrolled cell division and heterogeneity, including surgery (e.g., laparoscopic rectal surgery and robotic surgery) [11,12], photothermal therapy (PTT) [13][14][15], radiotherapy [16], chemotherapy [17], oncolytic virotherapy [18], RNA vaccine [19,20], hormone therapy [21], peptide-based neoantigen vaccine [22,23], gene therapy [24][25][26], immunotherapy (e.g., immune cells and checkpoint inhibitors) [2], and even nanomaterial-mediated nanotheranostics (e.g., organic nanomaterials, inorganic nanomaterials, and organic-inorganic hybrid nanomaterials). Nevertheless, the aforementioned strategies have also revealed inherent shortcomings (e.g., severe toxicity, off-target effects, graft-versus-host disease, and drug delivery barriers), which collectively hinder the further improvement in cancer administration [27,28].…”

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“…Rowcroft et al 1 . investigated this phenomenon analysing the surgical exposure of New Zealand general surgical trainees to two sub‐specialities (HPB and transplantation).…”

“…The design of the GSET programme appears to be able to improve the balance between core and specialty specific training in general surgery, provide a better assessment of autonomy and address some of the concerns raised in the studies by Rowcroft et al 1 . and Belvedere et al 2 .…”