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: drr@clos.net

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