Surgical Oncology Rd 2

Pearls from the Pancreas

100

On top of what vessel is the distinction between the pancreatic head and body?

Superior mesenteric vein

200

What is the name of this complication after pancreaticoduodenectomy that is often associated with nausea/bloating/regurgitation which may be aggravated by an underlying pancreatic leak?

Delayed Gastric Emptying 

300

When you are Kocherizing the duodenum, what structure delineates the completeness of the Kocher?

Takeoff of the left renal vein 

400

In a patient with obstructive jaundice from a pancreatic head mass, what type of stent should you place if you anticipate neoadjuvant chemotherapy?

Self expanding metal stents 

500

Name the guidelines often used to help differentiate when to operate on an IPMN?

Kyoto Guidelines 

The ‘Roid

100

What is the name of the pathologic classification of thyroid nodules which help guides risk of malignancy and treatment?

Bethesda classification 

200

Approximately 25% of Medullary thyroid cancer have a germline mutation in this protooncogene

RET

300

What test do you send from a FNA of a lymph node you are worried about thyroid cancer?

thyroglobulin 

400

What is an indication for Radioactive iodine after total thyroidectomy? (Most answers get points)

1.) Tumor size >4cm 

2.)Differentiated high grade carcinoma

3.)Cervical nodal metastasis (consider for any, highly recommended >5)

4.) Postoperative unstimulated Tg >10ng/mL

5.) Vascular invasion

500

This often can mimic anaplastic thyroid cancer by presenting as a rapidly expanding thyroid mass

Thyroid lymphoma

“Liver Let Die”

100

Name of interventional radiologic procedure to induce liver hypertrophy on Contralateral side

Portal vein embolization

200

This maneuver is when you clamp the portal triad and providing infra and suprahepatic IVC occlusion 

total hepatic vascular isolation 

300

What is the functional liver remnant required for someone who has a background of cirrhosis?

40%

400

What is the target number of lymph nodes in a portal lymphadenectomy for intrahepatic cholangiocarcinoma?

6 lymph nodes 

500

Name the two drug regimen for locally advanced HCC that has been deemed unresectable and not a candidate for transplant 

Atezolizumab 

Bevacizumab 

NET-WORK

100

This triad seen in a functional neuroendocrine tumor of the pancreas causes symptoms of weakness and confusion, glucose <70, and documentation during a spontaneous symptomatic episode 

Whipple’s triad insulinoma 

200

What is the specific radionucleotide tag used for PET scans for Neuroendocrine tumors?

PET-DOTATATE 

300

What is the Ki67 proliferation rate in a Grade 2 neuroendocrine tumor?

2-20%

400

These make up the boundaries of the Gastrinoma triangle (Passaro Triangle) where 90% of gastrinomas are found

1.) Confluence of cystic duct and common bile duct

2.) Second and third portion of the duodenum inferiorly 

3.) Neck of the pancreas medially

500

First line therapy for Neuroendocrine tumors who are SSTR positive and Ki67>10% with significant clinical tumor burden where a somatostatin analogue is chelated to a radionuclide (Lu-177) which caused DNA damage and cell death

PRRT

Peptide Receptor Radionuclide Therapy 

The Palliative Polish

100

In a patient with a gastric outlet obstruction, this surgery allows the patient to continue eating

Gastrojejunostomy 

200

This procedure is done in patients with an obstructing rectal mass in the setting of metastatic disease

Diverting loop colostomy 

300

How do you manage bleeding in an unresectable gastric cancer patient?

Palliative SBRT (Short course radiation, 5 fractions)

400

What procedure can you perform to help alleviate severe abdominal pain either from chronic pancreatitis vs. locally advanced pancreatic cancer?

Celiac plexus block 

500

Management of a malignant small bowel obstruction in the setting of PCI of 29?

PEG tube