Global Opportunities: The KSSO Observership Opportunity

Shaila Merchant, MDShaila Merchant, MD of Queen’s University in Kingston, Ontario, Canada was recently awarded with the 2019 Korean Society of Surgical Oncology (KSSO) Observership opportunity. She recently returned from her ten-day trip, during which she attended the Seoul International Symposium of Surgical Oncology meeting and spent time at Seoul National University Hospital under the mentorship of Han-Kwang Yang, MD, Chairman of the Board of Directors of the KSSO. Dr. Merchant spent a few moments to describe her experience to SSO Staff.

Q: What was appealing about the KSSO Observership opportunity?

Dr. Merchant: Gastric cancer is an area of clinical and research interest for me. It was highly appealing to travel to an area with a much higher incidence of this type of cancer as it is not as common in North America.  And, many of the randomized clinical trials in gastric cancer come from South Korea and I was interested in learning more about their research infrastructure.

Q. What were your personal objectives for this program?

Dr. Merchant: There is a lot of controversy in the West about the extent of lymph node dissection related to gastric cancer. Surgeons in Korea and Japan have been performing these extended lymph node dissections in gastric cancer for a long time. It has only been recently that it has been adopted in Western countries. I was interested in seeing if the way I was taught is the way that surgeons in the East are performing the procedure. I also wanted to learn more about minimally invasive approaches to gastric cancer, specifically with respect to patient selection, positioning and key interoperative maneuvers, as I plan to incorporate this into my own practice in the future. And finally, I wanted to learn more about their own research and their infrastructure.

Q. What were the most interesting components of this opportunity?

Dr. Merchant: There were many interesting components of this Observership opportunity. I was very impressed with the caliber of research presented at the Seoul International Symposium of Surgical Oncology meeting and the spirit of collaboration amongst the speakers and the attendees.

When I began the Observership at Seoul National University Hospital, I was shocked to see what high volume of gastric surgeries, approximately three to five gastrectomies a day. In my own practice I probably do 25 – 30 cases per year. It was interesting to see the number of patients that present with gastric cancer and the number of ways they approach gastric cancer surgery. But, even more than that, the most interesting thing was how the presentation of gastric cancer is so different in South Korea compared to my own practice. For example, the majority of patients present with locally advanced proximal cancer, where as in South Korea the majority of patients present with early distal gastric cancer. It dawned on me that we are treating very different gastric cancers in the West as compared to the East. The disparities in presentation are striking and incredibly interesting.

Q. What are some of the key takeaways from this experience?

Dr. Merchant: My key takeaway is that there are many nuances in the management of gastric cancers. Some of these nuances are about the approach – open, laparoscopic, robotic or even endoscopic for the early cancers and the extent of the resection that can be distal gastrectomy, proximal or total gastrectomy. As well as the extent of lymph node dissection, which can be tailored to the stage and location of the disease and the various options for reconstruction to restore GI continuity. It was very interesting to see to see the wide varieties of approaches that are utilized at this institution and the way that the surgeons very carefully tailor their approach with each patient.

Q. What information do you plan to share or integrate into your own practice?

Dr. Merchant: I’m the only person that does gastric cancer surgeries at my institution, so I plan on slightly modifying my lymph node dissection technique based on what I learned in Seoul. And moving forward, when I have a patient with early distal gastric cancer I plan to perform the operation laparoscopically. I also plan to share these experiences to with my colleagues and surgical residents.

Q. What other information would you like to share?

Dr. Merchant: I am very grateful to be the recipient of the 2019 KSSO Observership. While I was only there a short time, it was very fruitful. Every day I was able to see multiple cases and have many of my questions answered by the surgeons. I was able to sit in on a research meeting and get a sense of their ongoing studies and gain an understand of how they can be so productive. They are very collaborative and have large research teams that allow them to be so productive – it takes a village when it comes to research and they have an excellent infrastructure in place.

The KSSO Secretariat did a fantastic job organizing my visit and the entire team including surgeons, fellows, residents, medical students and nurses were warm and welcoming. Professor Han-Kwang Yang, MD and his surgical group are skilled, knowledgeable and importantly, shared their knowledge and wisdom openly. The experience I gained from this observership will enable me to deliver better surgical care to my patients and the connections I have made will serve the basis for life-long collaborations and friendships.

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