Julie Hallet, MD MSc

🆕Team design as innovation in perioperative care: the case of HPB anesthesiology
➡️https://buff.ly/U5wd2VX

"Change takes time – in all fields, including surgery... But not all improvements require new technology."

@halletjulie.bsky.social #surgery #team #HPB #medsky #surgsky

. @nanets.bsky.social @enets.org @ascocancer.bsky.social

💥Bone mets in SI-NETs – more common than you think!

🦴25% on PET-CT
😌14% pain, 4% fracture
⏳Stage IV pts with 🦴 mets ⬇️ median survival vs without
📊>5 lesions has ⬇️ survival

What's the best strategy for bone treatments in #NETs? 💭

ow.ly/GB2N50WCokB

#NETSky #OncSky #MedSky #SurgSky

. @nanets.bsky.social @socsurgonc.bsky.social

💭Guess what day it is? #NETs OR 🦓 with Dr Meloche-Dumas

She’s focusing on NETs during surg onc fellowship. The NETs field needs more dedicated surgeons like her - watch out for what’s to come!

So fun to create tailored multidisciplinary NETs rotations with UofT SurgOnc
#NETsky #SurgSky #MedSky

Appendiceal Neuroendocrine Tumors: Prognostic Role of Mesoappendiceal Invasion and Implications for Recommending Right Hemicolectomy versus Simple Appendectomy - Annals of Surgical Oncology Background Current guidelines are conflicting as to whether mesoappendiceal invasion (MAI) among patients with appendiceal neuroendocrine tumors (aNETs) warrants right hemicolectomy (RHC), especially ...

Mesoappendix invasion not a criteria for right hemi in appendix NETs

👥4800 pts
🔬meso invasion not associated with LN+ on its own
📏size main risk factor

No difference in OS appendectomy vs right hemi👌

Timely for @nanets.bsky.social guidelines!

link.springer.com/article/10.1...
#NETSky #SurgSky

#HPBSky Also check out the great ergonomics in surgery primer from last year 📑 🔑 at @bjsacademy.bsky.social 👏🏻 @halletjulie.bsky.social

🆕 Ergonomics in the OR is a safety imperative
The OR looks choreographed—yet beneath it lie serious ergonomic hazards for the surgical team.

Read more on BJS Academy ⬇️
buff.ly/7QuQvlA

@halletjulie.bsky.social @bjsurgery.bsky.social #surgsky #medsky #surgery

Under pressure: live observation of ergonomic challenges in the operating room Ergonomics is the study of how people interact with their environment to improve efficiency and well-being. In the operating room (OR), poor ergonomic prac

OR under pressure⚡️

Live observations 👀 👉🏻multiple ergonomic hazards across types of surgeries
‼️poor layouts
🤸awkward postures
🏃trip risks
📟tech fails
Involving all team members😷

Time to make OR safe for workers!

📝🔗 academic.oup.com/bjs/article-...
#SurgSky #MedSky

. @nanets.bsky.social @enets.org @socsurgonc.bsky.social @essonews.bsky.social @ihpba.bsky.social @stefanopartelli.bsky.social

Defining high-risk pancreas #NETs

496 resections 🇮🇹🇫🇷🇨🇦

Early recurrence
71% if venous thrombosis
41% if Ki 67>5% + tumor >3cm + ⬆️LN

⚠️Signs of biologically borderline-resectable NETs
🛑 before resection ➡️ start with systemic💊

🔗 journals.lww.com/annalsofsurg...

#NETSky #HPBSky #PancSky #SurgSky

🎙️New data for management of #HCC
What is new?
What is in the works?

Review this & more with Adam
Yopp, Amit Singhal & Katie Kelley in new #SurgOncToday podcast 🎧 from @socsurgonc.bsky.social
A real masterclass in perioperative care for HCC 🔝

#HPBsky #SurgSky #medsky #oncsky

What will my life look like after surgery?

The STAYHOME tool can help with this question for older adults for cancer surgery:
🏡 individualized risk of staying home at 6 & 12 months
😷 uses preop info
✅ good discrimination & well calibrated

📝 in JAMASurgery lnkd.in/gTtRgj_e

#SurgSky #OncSky

#HPBSky #SurgSky

That was the last OR day with Dr Acher! Always bittersweet to see fellows go 🥹

So proud of the highly skilled, brilliant, whip-smart surgeon she is 🌟 @wiscsurgery.bsky.social, you're lucky to have her!

Now, we can always dream of getting her on social media 🙃

@uoftsurgery.bsky.social

#MedSky #HPBSky #SurgSky #PancSky @socsurgonc.bsky.social

Great Debate: Chasing Intraoperative Neck Margins During Pancreatoduodenectomy—Beneficial or Not? - Annals of Surgical Oncology Annals of Surgical Oncology -

Should we chase margins intraop for PDAC?

✅Yes - R0 is key for cure
❌No - R1 reflects biology, not technical cure

Great summary & sharp debate on surgical cure vs disease reality from #SSO2024 in @annsurgoncology.bsky.social between Alice Wei & David Kooby

link.springer.com/article/10.1...

NeoPancONE: GATA6 expression as a predictor of benefit to peri-operative modified FOLFIRINOX in resectable pancreatic adenocarcinoma (r-PDAC): A multicentre phase II study. 4011Background: Modified FOLFIRINOX (mFFX) is increasingly used in the perioperative setting in r-PDAC and patients (pts) would benefit from a biomarker approach. GATA6 expression enriches for the cla...

Sub-typing to select NAT in #PDAC?

NeoPancONE 🇨🇦 #ASCO25 @ascocancer.bsky.social

👥84 resectable PDAC
💉mFOLFIRINOX NAT
Median OS 34 months😀
🔬Classical vs basal sub-type main predictor EFS & OS

What next 🤔: sub-type all PDAC prior to chemo? wait for more data?

ascopubs.org/doi/10.1200/...

Not in Chicago but getting the updates - #ASCO25 learnings today:

😀there's an option in BRAFV600 mCRC
😀Ipi+Nivo better in MSI-h unresectable mCRC
🫤ctDNA+ still not guiding care in CC
😳CRS+HIPEC no better with chemo

@oncbrothers.bsky.social
got the details 👉🏻 tinyurl.com/bd75xjw7

#OncSky #MedSky

Stable OR teams contribute to better outcomes🤝✨

Each additional case done by same anesthesiologist-surgeon team 👉 ⬇️ major morbidity

🔓‼ Opportunity is knocking: ⬆️outcomes by re-organizing teams

How do we do it?

🆕📝 tinyurl.com/yx44pm96

#SurgSky #MedSky #HPBSky

PRRT before surgery in #NETs? ☢️🦓

Maybe? 💭

Think about why, how to measure success, potential risks 🤔

Some key reasons to consider the approach by Jess Maxwell @mdanderson.bsky.social 👇🏻

@nanets.bsky.social
#NETsky #HPBSky #SurgSky
@enets.bsky.social @socsurgonc.bsky.social

#NETs in LA ⭐️🎥🌴

Reminder to debulk NETs liver metastases by Alexandra Gangi 🤩 @cedarssinai.bsky.social

➡️ mortality in NETs happens in the liver - treat it

⛔️ No to anatomic resection! 👉🏻 enucleate!

#NETsky #HPBSky #SurgSky #OncSky
@nanets.bsky.social

Perioperative management essentials for carcinoid syndrome

🎞️👀 sneak peek of 🗺️ international expert consensus recommendations at @essonews.bsky.social #NETs webinar today
🔹Assess for 🖤disease
🔹Identify & treat crisis fast
🔹Don't rely on octreotide!

Thanks for the invite!
#NETSky #HPBSky #SurgSky

New favourite slide from @drcnclarke.bsky.social on surgery for #PNETs 🟢🟠🔴
at AHPBA monthly fellows rounds

@nanets.bsky.social @enets.bsky.social @socsurgonc.bsky.social #NETSky #HPBSky #PancSky #SurgSky

. @nanets.bsky.social @oncothor.bsky.social @pamelakunzmd.bsky.social @heloisasoares.bsky.social @drcnclarke.bsky.social

Symptoms & QoL are key in #NETs care

New tools🧰 from @ascocancer.bsky.social for symtpom management in well-diff GEP-NETs
☑️carcinoid syndrome, heart disease, crisis & functional PNETs
☑️surgery, liver-directed therapy & systemic

🔗📝https://ascopubs.org/doi/10.1200/OP-25-00133
#NETSky #OncSky

@nanets.bsky.social @enets.bsky.social @oncothor.bsky.social @heloisasoares.bsky.social @ja

Want to know more about surgery & functioning NETs?🤨

Join @essonews.bsky.social on May 14!

🔥Will include preview of international expert consensus recommendations for periop management of carcinoid crisis🦓🌎

Register 👇🏻👇🏻

#NETSky #SurgSky #OncSky #HPBSky

#SurgSky #MedSky #OncSky

Are current wait time targets optimal?

Strong work by Adom Bondzi-Simpson #AmerSurg25:
wait time & survival in #CRC
🚫 diff OS if surgery <28d (traditional target)
⬆️OS if surgery <45d (new)

Time to reconsider wait times to optimize cancer outcome vs resources? ⚖️🤔

📸cred @swexner.bsky.social