1. a-00041 Dr. Robert RUTLEDGE Title of Paper: FEAR OF CANCER AFTER BILLROTH IIASSOCIATED WITH LOWER KNOWLEDGE OF GASTRIC CANCER, GENERAL/BARIATRIC SURGERY Nationality: United States of America Position: Director Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery Tel: +1-702 714 0011 E-mail: email@example.com
2. FEAR OF CANCER AFTERBILLROTH II ASSOCIATED WITH LOWER KNOWLEDGE OF GASTRICCANCER, GENERAL/BARIATRIC SURGERY Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
3. Fear of Cancer
4. Introduction• As part of a pre-conference survey for the MGB/OAB Consensus Conference we asked Expert Surgeons a variety of questions related gastrointestinal surgery, bariatric surgery and gastric and esophageal cancer
5. Methods:• Survey of International Bariatric Surgeons
7. Fear of CancerFoC Surgeons
8. • Fear of Cancer Surgeons (FoC)• Study Goals• What do they know• What do they think• Identify Cognitive Biases (Restrictive Freedom Reaction, etc.)• Compare to Non-FoC Surgeons
9. FoC Surgeons• Do Not Know• MGB• Billroth II• Bile reflux• Or• Gastric Cancer
10. Fear of Cancer Surgeons: Error Day Week Month FoC Surgeons: Error
11. MGB Surgeons
12. Fear of Cancer Surgeons (FoC): Error FoC Surgeons: Error
13. Cognitive Bias• “Reactance is what happens when you feel your freedom is threatened”• Reactance – “the urge to do the opposite of what someone wants you to do out of a frustration of losing... “• Occurs when an attempt to constrain freedom of choice
14. Fear of Cancer Surgeons (FoC): Error FoC Surgeons: Error
15. FoC Surgeons: 15% Error FoC Surgeons: Error
16. FoC Surgeons: Correct
17. FoC Surgeons: ERROR FoC Surgeons: Error
18. More Dangerous• Hot Dog 50 gm (Processed Meat)• Billroth II
19. FoC Surgeons: Error This Is True FoC Surgeons: Error
20. FoC Surgeon: Error FoC Surgeons: Error
21. FoC Surgeons• To Restate:• Surgeons who Fear Gastric Cancer• Admit• They are NOT very knowledgeable about Gastric Cancer• And• This CONFIRMED by their Answers!
22. FoC Surgeon: Correct!
23. FoC Surgeons• To Restate:• FoC Surgeons Agree• 1. H.Pylori Primary Cause Gastric Cancer• 2. H.Pylori Eradication Prevents Gastric Cancer• Yet• They Fear Gastric Cancer after BII?
24. FoC Surgeons: Error FoC Surgeons: Error
25. FoC Surgeons: Error FoC Surgeons: Error
26. FoC Surgeons: Error
27. FoC Surgeons: Error
28. FoC Surgeons: Error
29. FoC Surgeons: Error
30. Conclusions:• Survey of Bariatric Surgeons show some surgeons fear Gastric Cancer after Billroth II used in MGB• Those who fear gastric cancer report they have not recently reviewed literature on Gastric Cancer• Surgeons with fear of GCa recognize that the risk of GCa after BII is low (less than eating a small amount of processed meat (Hot Dog))
31. Conclusions• FoC incorrectly predict that MGB patients will vomit bile once day / week / month!• MGB surgeons report that the incidnce of biliary vomiting is rare (less than 1-2 / year)• Many (40%) but not all, FoC Surgeons recognize that BII in studies of GCa are done for ulcer disease and ulcer increases the risk of GCa• While 58% of FoC surgeons agree that oncologists routinely use the BII in treatment of gastric cancer; but 42% disagree.
32. Conclusions• Surgeons who fear gastric cancer are often correct about many questions related to MGB/BII & GCa;• But in many important cases they are incorrect when asked questions about gastric cancer and MGB/Billroth II and this may explain their Fear of Gastric Cancer following MGB/BII