
Hosted by Behind The Knife: The Surgery Podcast · EN

Circulating tumor DNA (ctDNA), a minimally invasive blood-based biomarker, has emerged as one of the most promising advances in cancer surveillance. Today, we will explore how ctDNA is transforming the management of colorectal cancer and anal squamous cell cancer across the disease continuum—from risk stratification and adjuvant therapy decision-making to surveillance and early detection of recurrence. Through landmark clinical trials, real-world applications, and emerging research, we will examine how ctDNA is helping move cancer care closer to the goal of truly personalized medicine.Hosts: · Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center· Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian· Dr. Philip Bauer, Assistant Professor of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital· Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer CenterGuests:Dr. Paul Romessor · Director of Colorectal and Anal Cancer, Department of Radiation Oncology· Associate Attending Radiation OncologistMemorial Sloan Kettering Cancer CenterDr. Jeanne Tie · Medical Oncologist | Lower GI Unit · Lower GI Research Lead · Chair | Lower GI Working Party | GI Cancer TrialsPeter MacCallum Cancer Centre Dr. Takayuki Yoshino· Professor, Global Center of Research Excellence for Advanced Medicine (G-CORE),Keio University School of Medicine· Executive Advisor to Hospital East Director· Director, Department of Global Oncology· Chief, Department of Gastrointestinal OncologyNational Cancer Center Hospital EastLearning Objectives:· Describe the biological basis and clinical applications of circulating tumor DNA (ctDNA) as a biomarker of minimal residual disease (MRD) in colorectal cancer.· Interpret the prognostic significance of postoperative and longitudinal ctDNA testing and its role in predicting recurrence risk across stages of colorectal cancer.· Evaluate evidence from landmark clinical trials, including DYNAMIC and GALAXY, supporting ctDNA-guided treatment de-escalation and escalation strategies in colorectal cancer.· Discuss emerging applications of ctDNA monitoring in personalized cancer care, including surveillance, treatment response assessment, and future clinical trial directions. References:· Ando, K. et al. (2026). Molecular Residual Disease and Recurrence in Rectal Cancer Patients Undergoing Upfront Surgery: A Prospective Cohort Study. Annals of Surgery. https://pubmed.ncbi.nlm.nih.gov/39854721/ (Note: If direct access is limited, the article is available via PMC: PMC12695342)· Romesser, P. B. et al. (2026). Tumor-informed circulating tumor DNA stratifies recurrence risk and survival in anal squamous cell carcinoma. Nature Communications. https://pubmed.ncbi.nlm.nih.gov/38347209/· Tie, J. et al. (2025). Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39943485/· Tie, J. et al. (2025). Circulating tumor DNA-guided adjuvant therapy in locally advanced colon cancer: the randomized phase 2/3 DYNAMIC-III trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39974258/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/). The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too! A favorite feature is the annual debates. Today, we are featuring a showdown between Drs. Bryan A. Cotton, MD, MPH and Marty A. Schreiber, MD, FACS, FCCM, FCRST (Hon), COL, MC, USAR as they debate REBOA as a Life-Saving Intervention in Hemorrhagic Shock. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE! TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/trauma-surgery-video-atlasPreparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/). The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too! A favorite feature is the annual debates. Today, we are featuring a showdown between Drs. Carlos V.R. Brown, MD, FACS and Katie W. Russell, MD as they debate WHETHER OR NOT PEDIATRIC PANCREATIC INJURIES CAN BE MANAGED NON-OPERATIVELY. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE! TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/trauma-surgery-video-atlasPreparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join us as we discuss research on mental health and wellbeing in the surgical workforce with Drs. Yang and Collins. The episode explores key findings from recent national surveys showing that nearly one in seven surgeons report suicidal ideation in the past year, with depression, anxiety, and PTSD affecting 15–20% of the surgical population. The conversation highlights protective factors—professional fulfillment, resilience, self-valuation, and connection—while distinguishing between healthy resilience and normalized suffering. Dr. Yang and Dr. Collins discuss systemic barriers including time constraints, out-of-pocket mental health costs, and persistent stigma, alongside actionable institutional interventions: protecting dedicated wellbeing time, establishing peer support and psychological first aid programs, ensuring free mental health access, and expanding research to understand what helps surgeons thrive. The episode emphasizes that self-care is essential to patient safety and invites listeners to become advocates, engage with the literature, and help drive culture change within their institutions. For more information about the AAS wellbeing survey, please email Dr. Yang at CJYANG@MGH.HARVARD.EDU.Host: Steven Thornton, MD (General Surgery Resident at Duke University) Agnes Premkumar (General Surgery Resident at Creighton) Guests: Jeff Yang, MD (Massachusetts General Hospital) Reagan Collins, MD (University of Pennsylvania) Publications Discussed: Hughes TM, Collins RA, Cunningham CE. Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce. JAMA Surg. 2024 Jan 1;159(1):7-8. doi: 10.1001/jamasurg.2023.4658. PMID: 37792380. [https://pubmed.ncbi.nlm.nih.gov/37792380/] Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg. 2024 Mar 1;279(3):429-436. doi: 10.1097/SLA.0000000000006159. Epub 2023 Nov 23. PMID: 37991182. [https://pubmed.ncbi.nlm.nih.gov/37991182/] Yaghmour NA, Bynum WE 4th, Hafferty FW, Könings KD, Richter T, Brigham TP, Nasca TJ. Causes of Death Among US Medical Residents. JAMA Netw Open. 2025 May 1;8(5):e259238. doi: 10.1001/jamanetworkopen.2025.9238. Erratum in: JAMA Netw Open. 2025 Jul 1;8(7):e2523489. doi: 10.1001/jamanetworkopen.2025.23489. PMID: 40366660; PMCID: PMC12079293. [https://pubmed.ncbi.nlm.nih.gov/40366660/] Nasca BJ, Hunt ML, Ramirez RT, Eng JS, Li RD, Agarwal G, Bilimoria KY, Hu YY. One is too many: suicidality among general surgery residents. Acad Med. 2025 Dec 24:wvaf105. doi: 10.1093/acamed/wvaf105. Epub ahead of print. PMID: 41819820. [https://pubmed.ncbi.nlm.nih.gov/41819820/] Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

INTRODUCING Behind the Knife OBGYN Oral Board Review!The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it’s a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.Each scenario includes 2 parts. The first part is a perfectly executed scenario. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.Please check out the preview episodes below that include Parts A and B, with and without commentary.This course includes access to our Oral Board Simulator. Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available. 3-Month Purchase - 10 exams 6-Month Purchase - 22 exams 12-Month Purchase - 46 exams Learn More: https://behindtheknife.org/premium/obgyn-oral-board-reviewDOMINATE THE DAY!

Join Drs. Georgoff, Burke, and Premkumar in this episode of the EPA Playbook as they break down a practical, repeatable framework for managing patients in the trauma bay, one of the most high-pressure environments in surgical training. This episode focuses on the critical first minutes of evaluation, anchored in a structured primary survey. We emphasize how to recognize and immediately address life-threatening injuries, while maintaining situational awareness and clear communication with your team. From airway and hemorrhage control to adjuncts like FAST and early imaging, we highlight what matters most when time is critical. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. BTK Resources:Trauma Video Playlist (FAST, How to Read a CT, and more!)https://behindtheknife.org/video-playlists/trauma-videosBig T Trauma Podcastshttps://behindtheknife.org/podcast-series/big-t-traumaTrauma Surgery Video Atlas (Premium)https://behindtheknife.org/premium/trauma-surgery-video-atlas

Join Drs. Georgoff, Burke, and Premkumar in this episode of EPA Playbook, where we tackle the evaluation and management of small bowel obstruction. Through a realistic series of scenarios, we walk step-by-step through how junior residents can approach this diagnosis using an evidence-based approach.We break down the key components of the small bowel obstruction EPA, from rapid initial assessment and focused physical exam to early resuscitation, recognizing when to go straight to the OR, and post-operative care. Along the way, we highlight critical teaching points you’ll actually use on call. Whether you’re a new intern or an early resident looking to build confidence, this episode is designed to help you act decisively and move one step closer to entrustment. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.BTK Resources:Nasogastric Tube (NGT) Management Videohttps://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-managementNasogastric Tube (NGT) Placement Videohttps://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-placementOstomy Marking Videohttps://behindtheknife.org/video/behind-the-knife-ostomy-markingHow to Change an Ostomy Appliance Videohttps://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-applianceHow to Manage a Challenging Ostomy Videohttps://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomyCited Studies: National prospective cohort study of the burden of acute small bowel obstruction https://doi.org/10.1002/bjs5.50136 Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study https://doi.org/10.1007/s00068-022-02171-y Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction https://doi.org/10.1097/ta.0000000000001499 Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline https://doi.org/10.1097/ta.0b013e31827019de

In this episode of EPA Playbook, Drs. Jason Bingham, Emma Burke, and Agnes Premkumar discuss the evaluation and management of inguinal hernias through a case-based approach that reinforces key EPA concepts for surgical trainees. We specifically highlight the importance of a thorough history and physical exam, emphasize risk stratification, and indications for surgery versus watchful waiting. We briefly review a few postoperative considerations as well. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. Cited studies:Miserez M, et al. "Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients." Hernia. 2014;18(2):151-163. PubMed ID: 24504225Carrick MA, et al. "Smoking and anaesthesia." BJA Educ. 2019;19(1):1-6. PubMed ID: 33456860Amid PK, et al. "Local anesthesia for inguinal hernia repair step-by-step procedure." Ann Surg. 1994;220(6):735-737. PubMed ID: 7979603Huy TC, et al. "Reoperation for chronic postoperative inguinal pain." JAMA Surg. 2025;160(9):984-991. PubMed ID: 39855588

In this episode of EPA Playbook, Drs. Kevin Kniery, Emma Burke, and Agnes Premkumar discuss management of critically ill surgical patients, using case-based discussions to reinforce core principles of shock, resuscitation, and ICU care. We first review the four major types of shock. We then discuss two cases centered around managing a patient in septic shock and cardiogenic shock, delving into the nuances on how management differs between the two. Additionally, we underscore a physiology-driven approach to critical care, the importance of multidisciplinary collaboration, and the need to align treatment decisions with patient goals and values. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.

Join Drs. Steele, Burke, & Premkumar in this episode of EPA Playbook, where we tackle a core general surgery EPA: the evaluation and management of benign and malignant colon disease. From common presentations like diverticulitis and lower GI bleeding to the diagnosis and workup of colon cancer, this episode provides a structured framework you can use on the wards, in clinic, and on call. Using case-based discussions, we walk through how to distinguishing benign from malignant processes, selecting appropriate imaging and endoscopy, and recognizing when a patient needs urgent intervention versus outpatient workup. We also cover key principles of colon cancer management, including staging, surgical planning, and multidisciplinary care, alongside high-yield management of benign conditions.***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. Cited Studies:Gustafsson, U.O., Scott, M.J., Hubner, M. et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 43, 659–695 (2019). https://doi.org/10.1007/s00268-018-4844-yBTK Resources:Ostomy Marking Videohttps://behindtheknife.org/video/behind-the-knife-ostomy-markingHow to Change an Ostomy Appliance Videohttps://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-applianceHow to Manage a Challenging Ostomy Videohttps://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy