November 2022 Department of Surgery Newsletter

SURGERY NEWS November 2022

NOTES FROM THE CHAIR As the end of the year approaches, it is an excellent time to stop and take note of all that we have accomplished over the past few months.

Some of those achievements include more than 20 of our surgeons being recognized as Top Doctors by 5280 Magazine, our cardiothoracic division continuing global efforts to bring surgical training to Nepal, and our research in several areas leading to better patient outcomes. In addition, we continue to build a department full of uniquely talented and diverse individuals, and we welcome all who have joined us.

Our faculty continue to provide unique opportunities for medical students, residents, and fellows working in our labs and clinics. And I continue to be impressed with our staff’s innovation, creativity, and flexibility as they provide the structure needed to sustain our department’s efforts.

With many winter celebrations and gatherings approaching, please take time to refresh and be present with loved ones.

I hope you enjoy reading about our accomplishments highlighted in the following pages.

Richard D. Schulick, MD, MBA Professor & Chair, CU Department of Surgery Director, CU Cancer Center The Aragón/Gonzalez-Gíustí Chair

DECADES OF SERVICE IN NEPAL

ISSUE HIGHLIGHTS 5

DOD AWARD RECIPIENT

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RETURN TO OR 10

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2 Frederick Grover, MD, former chair of the Department of Surgery and professor emeritus of cardiothoracic surgery, returned to Nepal 16 times, helping to establish and grow partnerships between Nepali and University of Colorado clinicians.

ESOPHAGEAL CANCER

OLDER LUNGS AND TRAUMA

Surgery News

DECADES OF PUBLIC HEALTH SERVICE IN NEPAL Frederick Grover, MD, first visited Nepal in 2000 and since then has worked to support Nepali colleagues in cardiac surgery and nutrition initiatives.

Rachel Sauer

Frederick Grover, MD Professor Emeritus Cardiothoracic Surgery

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When Frederick Grover, MD, former chair of the Department of Surgery and professor emeritus of cardiothoracic surgery, first landed in Nepal in November 2000, it was the people he met who made him feel like he’d found a second home.

“The kindness people showed me, the welcome they gave, the warmth, was truly exceptional,” Grover recalls. “Even though that first trip wasn’t a medical visit, I could see that people would welcome us as partners in working on public health issues.”

Grover has returned to Nepal 16 times, helping to establish and grow partnerships between Nepali and University of Colorado clinicians.

Grover has been involved with initiatives including the founding of the Jayanti Memorial Trust, which serves cardiac patients throughout Nepal; grant funding for cardiac initiatives through Every Heartbeat Matters; and the establishment of nutritional rehabilitation homes throughout Nepal in partnership with the Nepal Youth Foundation.

Since that initial trip, which was sponsored by Montview Boulevard Presbyterian Church in Denver,

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November 2022

21 CU Surgeons Recognized as 5280 Magazine Top Doctors for 2022 School of Medicine

OLIVIA NEWTONJOHN DIES AFTER 30-YEAR BREAST CANCER BATTLE Greg Glasgow According to CNN, Olivia Newton-John was first diagnosed with breast cancer in 1992, after which she underwent a partial mastectomy, followed by chemotherapy and breast reconstruction. The cancer went into remission but returned in 2013 as a tumor in her shoulder. The

cancer resurfaced again in 2017 as a tumor at the base of the singer’s spine.

Denver-area magazine 5280 recently published its list of top doctors for 2022. On this year’s list, CU School of Medicine faculty members continue to be ranked among the best. We’re proud to congratulate the 193 CU School of Medicine faculty members honored with the title “Top Doctor.”

The list is compiled from a survey of Denver-area physicians asking them “whom they would trust to treat themselves or a loved one” in a variety of specialty-based categories. This year, 21 surgeons in 12 specialties were recognized as Top Doctors.

That length of time between recurrences is not uncommon with breast cancer, says Nicole Christian, MD, associate professor of surgical oncology.

ARCS SCHOLARSHIP RECIPIENT Greg Glasgow ARCS Foundation, a national nonprofit dedicated to supporting academically outstanding students in science, engineering, math, technology, and medical research, has awarded a $7,500 scholarship to Anna Lee, a second-year medical student.

Lee was recognized specifically for her work in the lab of Kia Washington, MD, a professor of plastic and reconstructive surgery whose research is devoted to restoring vision through whole eye transplantation.

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Surgery News

WELCOME NEW HIRES FACULTY Yanik Bababekov, MD Assistant Professor Transplant Surgery Kristine Corkum, MD Assistant Professor Pediatric Surgery Lyndsay Deeter, MD Assistant Professor GI, Trauma, and Endocrine Surgery Cheryl English, NP Instructor Vascular Surgery

Jessica Hughes, FNP-BC Instructor Urology

Cameron Carpizo Clinical Research Nurse Surgical Oncology

Yanique Madonna, PA-C Instructor Urology

Lauren Draper Research Services Clinical Program Manager Transplant Surgery

Benedetto Mungo, MD Assistant Professor Surgical Oncology Taylor Rasmussen, NP Instructor Transplant Surgery Jesse Schold, PhD Professor Transplant Surgery

Courtney Gargasz, PA-C Instructor Surgical Oncology Cameron Gibson, MD Assistant Professor GI, Trauma, and Endocrine Surgery Kweku Hazel, MD Assistant Professor GI, Trauma, and Endocrine Surgery Jordan Hoffman, MD Associate Professor Cardiothoracic Surgery

Connie Zuo, PA-C Instructor GI, Trauma, and Endocrine Surgery

STAFF Madison Bowie Administrative Assistant III Finance and Administration Courtney Breckenfelder Clinical Science Professional Pediatric Surgery

Featured Open Positions Colorectal Surgeon (Open Rank)

Night APP Surgical Subspecialty Service

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Theo Eckhardt Research Services Program Manager Finance and Administration Kyndall Hadley Research Clinical Services Professional Transplant Surgery Genevieve Kierulf Research Services Professional Pediatric Surgery Nino Lane Lab Technology I Center for Surgical Innovation Kelsey Livingston Program Coordinator Finance and Administration Danielle Mintzlaff Lab Professional Plastic and Reconstructive Surgery Marta O’Grady Division Administrative Director GI, Trauma, and Endocrine Surgery and Surgical Oncology Alyssa Ontiveros Residency Database Coordinator Office of Education Renee Pullara Executive Support Manager GI, Trauma, and Endocrine Surgery Ali Teimouri Laboratory Science Sr. Professional Urology

Finance and Business Anaylyst

Instructor NP/PA Burn Unit

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Devon Viart Surgery Simulation Specialist Office of Education

View all open positions.

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November 2022

DOD GRANT AWARDED TO CU SURGERY FACULTY MEMBER Christene Huang, PhD, is looking for noninvasive ways to detect rejection of vascularized composite allografts.

The COVID-19 Pandemic’s Effect on Solid Organ Transplantation Surgery resident Alejandro Suarez-Pierre, MD, found a significant decline in heart, lung, liver, and kidney transplants during the first half of 2020.

Greg Glasgow Solid organ transplants — heart, lung, liver, and kidney — are resourceintensive operations that require patients to take immunosuppressive drugs after the procedure to keep the body from rejecting the new organ.

Add a worldwide pandemic to the mix, and the operations become even riskier and more difficult to schedule.

Greg Glasgow Soldiers and others who receive severe injuries to the hands and face often can benefit from a type of transplant known as vascularized composite allograft (VCA) — the transplantation of multiple tissues, including muscle, bone, nerve, skin, and blood vessels, as a functional unit (such as a hand or face) from a deceased donor to a recipient with a severe injury.

Recipients of VCA grafts require longtime immunosuppression so their body doesn’t reject the transplant. Longtime immunosuppression presents problems of its own, however — including greater susceptibility to diseases such as cancer and infections including COVID-19 — so doctors are always

looking to balance the amount of immunosuppression a VCA recipient needs with the chances their body will reject the transplant.

Christene A. Huang, PhD, a professor of plastic and reconstructive surgery and transplant surgery in the Department of Surgery, is part of a research team that recently received a grant from the U.S. Department of Defense (DOD) to study noninvasive biomarkers of VCA rejection that would allow doctors to more quickly identify potential signs of rejection and adjust immunosuppression as necessary.

“From the perspective of a transplant surgeon, you don’t want to expose your patient to COVID-19 if they are now dependent on immunosuppressants,” says Alejandro Suarez-Pierre, MD, a general surgery resident in the Department of Surgery at the University of Colorado School of Medicine. “The other perspective is, as a hospital system, can you keep admitting patients for an operation when you’re having to open five or six new intensive care units to take care of the people afflicted by the pandemic?”

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Surgery News

FACTORS ASSOCIATED WITH RETURN TO OPERATING ROOM AFTER LIVER TRANSPLANT New research led by Hunter Moore, MD, PhD, shows that some liver transplant patients have a higher risk of requiring a second surgery within 48 hours.

Rachel Sauer

Hunter Moore, MD, PhD Assistant Professor Transplant Surgery

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Liver transplant surgery is a vital and life-saving procedure, but it also is associated with a high rate of postoperative complications. As many as one in four liver transplant patients will return to the operating room (R-OR) within 48 hours of their initial surgery.

a history of heavy alcohol use, saw an 80% R-OR rate. Further, researchers found that a triad of obesity, heavy alcohol use, and coagulopathy, or a decreased ability to form blood clots and stop bleeding, were associated with a 100% R-OR.

However, recently published research shows that certain risk factors can indicate a more likely R-OR, allowing patients, clinicians, and family members to more comprehensively prepare for this possibility.

“What this tells us is that if possible, we should try to not match a recipient with obesity with a donor who has a history of alcohol use,” explains Hunter Moore, MD, PhD, principal investigator on the study and an assistant professor of transplant surgery.

Liver transplant recipients with a body mass index (BMI) higher than 30, or what is considered obesity, who were matched with livers from donors with

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November 2022

U.S. Supreme Court Dobbs Decision Will Harm Women Diagnosed with Breast Cancer During Pregnancy Rachel Sauer

LATEST PROSTATE CANCER IMAGING TECHNIQUE Noelle Musgrave The PSMA/PET Scan is a newly acquired imaging technique at the University of Colorado Cancer Center that provides a more accurate picture of what patients are dealing with.

Paul Maroni, MD, associate professor of urology, explains, “This imaging technique is useful in many instances when treating men with

In a perspective published in The New England Journal of Medicine, Nicole Christian, MD, an assistant professor of surgical oncology in the CU School of Medicine, and Virginia Borges, MD, a professor of medical oncology, detail how the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization will harm some patients.

prostate cancer. First, it’s a better staging study for men diagnosed with high-risk diseases. It’s also a great study for men with rising PSA levels following treatment with radiation or surgery to see where cancer might be.”

MULTI-FACETED TREATMENT HELPS YOUNG BREAST CANCER PATIENT Amanda Vegter did not have time for whatever it was that she felt on the side of her left breast. She was only 35. She was busy. She had plans.

And because of aggressive, multidisciplinary care that included cutting-edge microsurgery, performed

by Justin Cohen, MD, assistant professor of plastic and reconstructive

surgery, she still has plans. She’s 36 now and eagerly looking down the road to a veterinary career, to more adventures with her dogs and her boyfriend, to time with her family, to the possibilities in each day that comes.

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Surgery News

What You Need to Know About Inguinal Hernias Paul Montero, MD, FACS, talks about symptoms, surgery, and more.

EXPLAINING PSA NUMBERS Paul Maroni, MD, explains what you need to know about PSA tests and the results.

Noelle Musgrave

Greg Glasgow One of the most common surgical procedures worldwide is the repair of inguinal hernias, hernias that occur in the groin. An inguinal hernia is tissue — sometimes intestinal tissue — that bulges out of a weak spot in the abdominal wall, below the belt line. Men are far more likely than women to get inguinal hernias, and the surgery is typically a low-risk, outpatient procedure.

We spoke with Paul Montero, MD, FACS, associate professor in the Department of Surgery at the University of Colorado School of Medicine, about hernias, the surgery, and when hernia belts — or trusses — are an appropriate temporary measure for pain relief.

The prostate-specific antigen (PSA) is a protein produced by the prostate gland. The PSA test is a blood test used to measure the amount of this protein found in the blood. Results are reported (ng/ mL), which means nanograms of PSA per milliliter of blood. High levels of PSA have been found in men with advanced prostate cancer.

“The PSA screening test helps to detect abnormalities in the blood that may indicate further testing is needed,” explains Paul Maroni, MD, associate professor of urology.

According to the guidelines outlined by the American Urological

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Association, shared decisionmaking for the early detection of prostate cancer is recommended for targeted groups of men with an increased risk of prostate cancer.

• 55-69 years old, all men of average risk.

• 40-54 years old for individuals with an immediate family member with a history of prostate cancer or Black/ African American men.

Over the age of 70, men should have a discussion with their doctor about whether PSA testing makes sense for them.

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November 2022

Research Shows Low Patient Comprehension of Cancer Terms Rachel Sauer

LIVING-DONOR LIVER TRANSPLANT RECIPIENTS GAIN LIFE-YEARS New research shows that more inclusive criteria for liver transplant eligibility allow for significant gains for more patients.

Rachel Sauer Research recently published in JAMA Surgery demonstrates that living-donor liver transplant (LDLT) recipients gain an additional 13 to 17 life-years following their surgery compared with patients who remain on the donor waitlist.

This research also pushes back against long-held standards that patients in need of a liver transplant should have a Model for End-stage Liver Disease incorporating sodium levels (MELD-Na) score of at least 15 to be considered for transplant.

Researchers found that patients with MELD-Na scores as low as 11 had a

34% decrease in mortality compared with those who remained on the waitlist.

“The really staggering part of the study was that we determined that the survival benefit is not something that increased by several months or even a year or two. The benefit that the patient can expect to gain is 13 years or more,” says Elizabeth Pomfret, MD, PhD, chief of transplant surgery in the University of Colorado School of Medicine and the senior author of the study.

Alexandra Verosky, a third-year medical student and her coresearchers, including research mentor Sarah Tevis, MD, assistant professor of surgical oncology, designed a survey to assess patient understanding of eight terms common in breast pathology reports: malignant, benign, metastatic, neoplasm, negative, mass, carcinoma, and high grade.

Here are the definitions for eight common cancer terms. How well do you comprehend them?

Mass: An abnormal collection of tissue or cells that may or may not be cancerous.

High Grade: A term used to describe cells that look abnormal under a microscope.

Benign: Not cancerous/nonmalignant.

Malignant: Cancerous; abnormal cells that can invade and destroy normal tissue or spread to other parts of the body.

Negative: The abnormality being looked for is not found/ not present.

Neoplasm: New growth/ abnormal growth which may or may not be cancer/tumor.

Carcinoma: Cancer originating from the lining layer (epithelial cells) of organs (or skin).

Metastatic: Cancer that has spread from the primary (original) site to other structures or organs.

Living-donor liver transplant recipients gain an additional 13 to 17 life-years following their surgery compared with patients who remain on the donor waitlist.

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Surgery News

ESOPHAGEAL CANCER PATIENT THRIVING & OPTIMISTIC AFTER MULTIDISCIPLINARY CARE Ken Herfert confidently expanded his family by four legs following his great response to a newly approved treatment and surgery from a specialized CU Cancer Center team.

Rachel Sauer Less than a year ago, Ken Herfert got a puppy and named her Bailey after the Colorado town where she was born.

This was a big deal for several reasons, including the responsibility of adopting a new family member, but perhaps the biggest was this: About six months after Herfert received a diagnosis of esophageal cancer in early 2018, his oncologist in California told him he had maybe a year to live, maybe less.

care for it? He figured he’d never have a dog again.

But after returning to his home state and working with a multidisciplinary team at the University of Colorado Cancer Center, Herfert is comfortable enough in his no evidence of disease (NED) status that he adopted an energetic Chesapeake Bay Retriever and is looking forward to years beyond the 64 he’s already lived.

How could he think about adopting a dog when he wouldn’t be around to

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November 2022

TELEHEALTH FOLLOW-UP AFTER GALL BLADDER SURGERY IS AS EFFECTIVE AS IN-PERSON CLINIC VISITS Greg Glasgow

Surgical resident Danielle Abbitt, MD, says the findings will help eliminate barriers to care.

A new research study by Danielle Abbitt, MD, a resident in the University of Colorado Department of Surgery, shows that a protocol that started as a necessity during the COVID-19 pandemic has evolved into a timesaving step for patients recovering from surgery.

Abbitt’s paper, published in August in the journal Surgical Endoscopy, shows that a telehealth appointment to follow up after a cholecystectomy (gall bladder removal), is just as effective as an in-clinic visit to detect and address postoperative complications including wound infections and cardiopulmonary complications such as pneumonia and pulmonary embolism. The

retrospective review was conducted on patients receiving care at the Rocky Mountain Regional VA Medical Center on the CU Anschutz Medical Campus.

“Based on my clinical experience seeing patients, my hunch was that the results would be similar between telehealth and a clinic visit,” says Abbitt, who also conducted a similar study on patients who undergo surgery to repair an inguinal hernia.

RECOGNIZING & PREVENTING PERIPHERAL ARTERY DISEASE Greg Glasgow

That pain when you walk could be more serious than you think. It could be a sign of peripheral artery disease (PAD), a condition in which a narrowing of the arteries results in reduced blood flow to the arms or legs. When the arms or legs — PAD typically affects the legs — don’t receive enough blood flow to keep up with demand, it can cause pain when walking and other symptoms.

PAD is usually a sign of a buildup of fatty deposits in the arteries, known

as atherosclerosis. Atherosclerosis is the most common cause of PAD, says Max Wohlauer, MD, associate professor of vascular surgery.

Atherosclerosis is a hardening of the arteries due to a buildup of plaque.

Atherosclerosis-related diseases are the leading cause of death in the United States.

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Surgery News

Period of Transition Teams and initiatives in the CU School of Medicine take on the challenges of pediatric-toadult transition of care Greg Glasgow For children with pediatric-onset chronic conditions, the relationships they form early on with their doctors and care team members often turn out to be among the most important connections of their young lives.

Years later, when those youth are on the cusp of adulthood and required to transition to adult care, the doctor-patient relationship becomes even more important, and thoughtful transition of care is critical.

The growing field of transitional care encourages collaboration among doctors to help young patients effectively manage the shift from pediatric to adult care, to encourage those patients to play a greater part in their own health care, and to improve health care systems to make those transitions more seamless.

It’s an area of growing importance at the University of Colorado School of Medicine, where several new initiatives are aimed at creating pathways and procedures to help young patients through one of the most important medical transitions of their lives.

WHY OLDER LUNGS DON’T RESPOND WELL TO TRAUMA Research completed at the University of Colorado Department of Surgery found that advanced age affects immune cells in the lungs.

Greg Glasgow

Why are older people at higher risk for lung injury, especially after trauma? The answer may lie in the macrophages, the immune cells that live in the air spaces of the lungs.

As a student at the University of Colorado School of Medicine, Devin M. Boe, MD, PhD — now a resident at Georgetown University School of Medicine — conducted research showing that aging impacts macrophages in the lung, causing them to be unable to work as effectively when the body is subjected to trauma. His paper was published in September in the Journal of Leukocyte Biology.

dysregulated with age,” Boe says.

“We wanted to know what’s going on chronically in healthy aging that affects that — what happens to the cells over time as an organism ages that explains why those cells may not be functional in the elderly.”

“What we found was that there is a particular protein called fkbp5 that is responsible for blocking the response to those stress hormones — it inhibits the glucocorticoid receptor and prevents the stress hormones from signaling within the cell and changing gene expression,” Boe says.

“The elderly are at much higher risk of lung infections and lung disease in general; we know that the immune system of the lungs gets 12

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November 2022

Thoracic Surgeons Launch Enhanced Recovery Plan for Patients Greg Glasgow

PAIN IN PEDIATRIC PATIENTS UNDERGOING SURGICAL STENT REMOVAL Kyle Rove, MD, found insignificant difference in pain levels between children who received ibuprofen before stent removal and those who received a placebo.

Rachel Sauer In a study published in the Journal of Pediatric Urology, researchers found that following a surgical ureteral stent removal procedure, children who had been given ibuprofen before the procedure did not report lower levels of pain in the 24 hours afterward than children who had received a placebo before the stent removal.

“There are still a lot of unknowns about using ureteral stents in pediatric patients, and one is just pain control in general,” explains study principal investigator Kyle Rove, MD, assistant professor of urology in the

University of Colorado Department of Surgery. “Though our hypothesis was rejected, we learned a lot about how to conduct a randomized control trial in a pediatric surgical population, which is not very common in research, and we got a clearer picture of how much research needs to be done on minimizing or preventing surgical patient pain or discomfort in pediatric patients.”

A new enhanced recovery protocol for patients undergoing lung resection surgery performed by faculty members in the University of Colorado Department of Surgery is resulting in patients going home sooner, experiencing less postoperative pain and complications, and taking fewer opioid drugs to manage their pain.

“Patients having surgery are prone to complications after surgery, and over the past decade or so, there has been a significant effort nationally and internationally to identify and streamline patient processes of care to try and minimize complications,” says Robert Meguid, MD, MPH, professor of cardiothoracic surgery in the CU School of Medicine, who designed the protocol with general surgery research resident Adam Dyas, MD. “These are efforts to develop streamlined protocols that apply to patients from when we first meet them in clinic through to their surgical encounter, all the way to their recovery,” Meguid says. “We are applying techniques that have been shown to decrease postoperative complications, such as wound infections, shorten length of stay, and improve quality-of-life outcomes and recovery from surgery.”

We studied one specific aspect of ureteral stents, which is during the time of removal, but sometimes patients need stents anywhere from one to 12 weeks.

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Surgery News

STUDY HAS POTENTIAL TO IMPROVE EDUCATION AND TREATMENT OF SEXUAL HEALTH FOR BREAST CANCER PATIENTS CU Anschutz researchers find patients would like better education and counseling about how treatment can negatively impact their sexual health Laura Kelley

A new study released by the University of Colorado Cancer Center shows that more than 70% of breast cancer patients have reported changes that affect their sexual health during and beyond treatment.

“More than 3.8 million breast cancer survivors live with permanent or temporary physical and psychological consequences of treatment that impact their sexual health. However, there is limited data that advises providers on the preferred format and timing of sexual health education,” said Sarah Tevis, MD, assistant professor of surgical oncology at the University of Colorado School of Medicine Campus.

The study, published in the Annals of Surgical Oncology, mentions that most oncology teams don’t discuss many of the potential sexual health effects of breast cancer treatment with patients.

“Patients we spoke with in focus groups all reported sexual side effects they were not prepared for during treatment. However, all expressed the desire to have those effects addressed early in the diagnosis and would like counseling to be available from the medical team,” Tevis says.

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