apc a-00041-fear of cancer-v2
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a-00041
Dr. Robert RUTLEDGETitle of Paper: FEAR OF CANCER AFTER BILLROTH II
ASSOCIATED WITH LOWER KNOWLEDGE OF GASTRIC CANCER, GENERAL/BARIATRIC SURGERY
Nationality: United States of AmericaPosition: Director
Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery
Tel: +1-702 714 0011E-mail: [email protected]
FEAR OF CANCER AFTER BILLROTH II ASSOCIATED WITH
LOWER KNOWLEDGE OF GASTRIC CANCER,
GENERAL/BARIATRIC SURGERY
Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
Fear of Cancer
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
Methods:
• Survey of International Bariatric Surgeons
Results
Fear of Cancer
FoC Surgeons
• 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
FoC Surgeons
• Do Not Know• MGB• Billroth II• Bile reflux• Or• Gastric Cancer
Fear of Cancer Surgeons: Error
FoC Surgeons: Error
Day
Week
Month
MGB Surgeons
Fear of Cancer Surgeons (FoC): Error
FoC Surgeons: Error
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
Fear of Cancer Surgeons (FoC): Error
FoC Surgeons: Error
FoC Surgeons: 15% Error
FoC Surgeons: Error
FoC Surgeons: Correct
FoC Surgeons: ERROR
FoC Surgeons: Error
More Dangerous
• Hot Dog 50 gm (Processed Meat)
• Billroth II
FoC Surgeons: Error
FoC Surgeons: Error
ThisIs True
FoC Surgeon: Error
FoC Surgeons: Error
FoC Surgeons
• To Restate:• Surgeons who Fear Gastric Cancer• Admit• They are NOT very knowledgeable
about Gastric Cancer• And• This CONFIRMED by their Answers!
FoC Surgeon: Correct!
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?
FoC Surgeons: Error
FoC Surgeons: Error
FoC Surgeons: Error
FoC Surgeons: Error
FoC Surgeons: Error
FoC Surgeons: Error
FoC Surgeons: Error
FoC Surgeons: Error
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))
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.
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