Roberto Bergamaschi1, Jin Ye Yeo2
1Department of Surgery, Jacobi Medical Center, New York City Health + Hospitals, New York, NY, USA; 2ALES Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. ALES Editorial Office, AME Publishing Company. Email: ales@amegroups.com
This interview can be cited as: Bergamaschi R, Yeo JY. Meeting the Editorial Board Member of ALES: Dr. Roberto Bergamaschi. Ann Laparosc Endosc Surg. 2024. Available from: https://ales.amegroups.org/post/view/meeting-the-editorial-board-member-of-ales-dr-roberto-bergamaschi.
Expert introduction
Dr. Roberto Bergamaschi (Figure 1) was born in Sicily and grew up in Milan, Italy where he obtained his MD degree. He completed his surgery residency at Strasbourg University, France and at Middlesex Hospital, in London, UK where he obtained his FRCS (Fellowship of the Royal College of Surgeons) (Engl.). He then completed a PhD in colorectal cancer at the University of Bergen in Bergen, Norway in 1996. Dr. Bergamaschi obtained his FASCRS in San Diego in 2001 and moved to the United States of America in 2003 to become director of the MIS Center and program director of the MIS fellowship at Allegheny General Hospital in Pittsburgh, PA, as well as Professor of Surgery at Hahnemann University in Philadelphia, PA. After obtaining his FACS (Fellowship of the American College of Surgeons) in New Orleans in 2004, Dr. Bergamaschi accepted the Indru Khubchandani Endowed Chair in colorectal surgery at Penn State University in 2005. He was appointed as associate editor of Diseases of the Colon & Rectum, the official journal of the ASCRS in 2007.
In 2008, Dr. Bergamaschi accepted a position as a tenured professor and chief of the Division of Colorectal Surgery at the State University of New York in Stony Brook, NY. The EAES (European Association of Endoscopic Surgery) nominated him as chairman of the Education and Training Committee in 2012. In 2013, he was nominated fellow of the American Surgical Association (ASA). In 2017 Dr. Bergamaschi accepted a position as chief of the Section of Colorectal Surgery, Department of Surgery at Westchester Medical Center and Professor of Surgery with Tenure at New York Medical College in Valhalla, NY. In 2023 Bergamaschi accepted a position as chief of Colorectal Surgery and Surgical Oncology, Department of Surgery at Jacobi Medical Center, New York City Health + Hospitals, The Bronx, NY.
Figure 1 Dr. Roberto Bergamaschi
Interview
ALES: What inspired you to pursue a career in colorectal surgery?
Dr. Bergamaschi: I started practicing colorectal surgery in France and Norway, but I realized that in Europe, colorectal surgery is not recognized as a formal specialty, and it is always merged with general surgery. Later, I moved to the US over 20 years ago and I realized that the US had colorectal surgery for a very long time, formalized in the 1960s as the American Society of Proctology. I find treating colorectal surgery patients to be very rewarding as they are very loyal and will follow up with you after you take care of them. We also have patients who are too young to be sick, generally from inflammatory bowel diseases, which is a very difficult group of people to treat. There are also lifestyle-related diseases like diverticulitis from our diets and sedentary lives. I find it a very fascinating specialty that also allows you to do your own colonoscopies as well as being a surgeon allows you to operate with the robot, laparoscopically or in traditional ways. You can also take care of perineal conditions like hemorrhoids.
ALES: What are some of the most significant advancements in the treatment of colorectal cancer that you have witnessed during your career?
Dr. Bergamaschi: Colorectal cancer these days is no longer just a lump to be removed by a surgeon. Colorectal cancer is now understood to be a disease that may involve all other organs of the body. The treatments have also been carried out with a number of other physicians with different specialties, such as medical oncologists, radiation oncologists, interventional radiologist, palliative care and others. Gastroenterologists trained in advanced endoscopy can offer endoscopic mucosal resection (EMR) or endoscopic sub-mucosal dissection (ESD) and colorectal surgeons my offer trans-anal robotic surgery (TAMIS). The quality-of-life and cure rates for colorectal cancer patients have improved. The main obstacle that remains is convincing the general population to undergo colonoscopy and prevent the development of a polyp into cancer.
ALES: Recently, your team published a paper on the bandwagons in colorectal surgery (1). Could you provide a brief overview of the current bandwagons in colorectal surgery, and share your perspectives on whether these bandwagons hold potential significance?
Dr. Bergamaschi: This is a very relevant question these days. I am not the first surgeon to bring up the issue, as there have been other surgeons publishing on this topic earlier. Actually, other fields such economics etc. have been studying bandwagons as a phenomenon. It is called the bandwagon effect, which essentially consists of a phenomenon where some surgeons become fascinated by their colleagues who may be performing procedures that seem to be fashionable and portrayed to be innovative. In fact, there is little to no evidence to support that such procedures are beneficial to the patients. There are also concerns regarding the fact it is often unknown how the patients are being informed and how the consent is being obtained from the patients to undergo such operations. Unfortunately, the bandwagon effect has been worsening and becoming more widespread in at least the past 10 years. One of the most devastating examples of the bandwagon effect has been involving patients with rectal cancer, jeopardizing some of the outstanding improvements that had been achieved in previous years. Another example involves patients presenting due to peritonitis to the emergency room. It is very questionable to believe that such patients in a state of anxiety can consent to a clinical study, where one of the options would be an operation that does not involve a temporary colostomy.
With regards to the care of patients with rectal cancer I have been conducting studies with some of colorectal surgeons in Norway resulting in recent publications aiming at calling out the bandwagon effect (2). Similarly, I have been cooperating with several US and European colorectal surgeons at publishing the data of laparoscopic lavage for patients who actually have a perforated sigmoid colon cancer, which occurs in up to 11% of the cases and remains undiagnosed up to 5 months (3).
ALES: Apart from bandwagons, are there any recent publications on colorectal surgery that stood out to you? What is the significance of these findings?
Dr. Bergamaschi: I have just co-authored a review (4), where I worked with colleagues from Norway on the issue of the forgotten nodes. In colon cancer, particularly the right side of colon cancer, there has been concern about the fact that surgeons in Europe and the US do not remove all the lymph nodes. This has been researched prospectively and I think it is something that should be popularized as is not known enough among surgeons who perform this operation for patients with colon cancer. The questions remains how many stage II patients are not referred to adjuvant chemotherapy when in fact their true stage is stage III on account of the nodes left behind.
ALES: As a past director of the Minimally Invasive Surgery (MIS) Center, how do you see the role of MIS evolving in colorectal surgery?
Dr. Bergamaschi: I think minimally invasive surgery has been as excellent step forward for colorectal surgery. Particularly because the extraction of colorectal specimens is not like extracting parenchymal organs. We are essentially extracting a tube, either the colon or the rectum. The extraction site can be minimalized or protected with a plastic bag. The use of robotic assistance has also offered advantages in the specific case of rectal cancer when compared to laparoscopic surgery. In fact, it is known that straight laparoscopic instruments are subject to the fulcrum effect at the abdominal wall resulting in a coning effect. Dissimilarly, the robot with its wristed instruments offers oncological advantages, namely wider circumferential resection margin.
ALES: With your consolidated training background in different centers and countries, could you share with us how it contributed to your career? What would be your advice for young trainees?
Dr. Bergamaschi: It reflects my career and the fact that I have been living and working in different countries. I think this has been a very unique opportunity to see different views and confronting different ways to take care of the same patients under different healthcare systems. It is not just about the therapy, but also the organization. I am alluding to the European government-run healthcare as compared to the private healthcare systems in the United States, with the advantages and disadvantages they both have. When it comes to young trainees, when I say that it is important to realize how extremely useful it is to compare your experience in your home country with a different country, I am not referring to surgical techniques. I am referring to the thought processes behind the decision making.
In fact, being European born before I moved to the US, I have had and still have many fellows coming over from Europe and spending time with me even from eastern Europe, and I think that many years later, when I ask them what they like about spending time with me and what changed after their fellowship is the thought process behind the decision-making.
ALES: How has your experience been as an Editorial Board Member of ALES?
Dr. Bergamaschi: My experience has been excellent. It was very simple and easy with fast communication and minimal if any difficulty at all. There is a lot of support and help, and there are many great and interesting results being published.
ALES: What are your expectations and aspirations for ALES?
Dr. Bergamaschi: My most important hope and expectation would be for ALES to be indexed by PubMed, so that it can be more accessible to more people to do a simple search.
Reference
- Felsenreich DM, Gachabayov M, Cianchi F, Bergamaschi R. Bandwagons in colorectal surgery. Minerva Surg 2023;78(2):194-200.
- Wasmuth H, Gachabayov M, Lee H, et al. Comment on: Beyond the trans-anal total mesorectal excision moratorium: local and distant recurrence among patients operated for low rectal tumours—5-year follow-up from a Norwegian University Hospital. Br J Surg 2024; 111(1):znad 418.
- Gachabayov M, Kajmolli A, Felsenreich DM, et al. Inadvertent laparoscopic lavage of perforated colon cancer. Langenbecks Arch Surg 2024;409 (1):35.
- Ignjatovic D, Bergamaschi R, Stimec BV. The forgotten nodes: a narrative review. ALES 2024.