Peter J. Allen, MD.

2009 James IVth traveling fellow summary

Introduction:

I was a James IVth traveler in 2009. I am an associate professor of surgery at Memorial Sloan- Kettering Cancer Center and my primary clinical and research efforts are on neoplastic diseases of the pancreas. My goals of the travel were to visit the major UGI and pancreas centers in Europe, Australia, and Asia.

This narrative is primarily for future travelers. I would encourage travelers to gain as much insight from previous fellows as possible as “we” are typically not accustomed to this type of experience. American surgeons in their mid-career do travel, but it is generally for 24 hours – or less – certainly not for a period of six weeks! It is not our custom to routinely visit foreign institutions simply for the purposes of sharing knowledge, developing collaborations and friendships, and spending time in other cultures. The James IVth was the single most valuable travel I have done in my career. It is a terrific experience. I will start with generalities about the trip, and then the specifics of my experience.

In general (for the future traveler):

Plan ahead. This trip should not be planned at the last minute. I decided to divide the time into two separate three week blocks of travel. The first leg was to Europe and the second to Australia and Asia. For each leg I began the process of planning approximately six months before departure. This allowed me to best align both the people I wanted to meet and the institutions I wanted to visit. I would recommend consultation with a former traveler as to which institutions match your interests and careful consultation with spouse/family as to which cities they would be interested in visiting (don’­t underestimate the value of the latter). I was very fortunate in that Murray Brennan served as my sponsor. We had multiple discussions about the best institutions to visit and the most interesting people to meet. He sent introductory letters/email which facilitated my subsequent correspondence. I have thanked him before, and I thank him again.

Limit the number of places you visit. This recommendation is my opinion based on my experience. The travel during this trip covers significant distance and more than a few time zones. Being able to visit the people, institutions, and city can be difficult in three days. My visit to Europe included five stops, and my visit to Australasia covered four. I feel that three to four stops is optimal. During my European leg I felt rushed, and felt that I did not spend as much time visiting the institutions, meeting the relevant members, and visiting the cities as I would have liked.

Bring family if you can. You spend enough time away from your family while here. I would recommend trying to bring family for this trip. The distances are far, the cost can be high, and coordinating spousal and/or children’­s schedule can be difficult, but it is worth these efforts. My wife Sarah and our three boys (8, 8, and 10) made part of the leg to Europe (Edinburgh) and it was absolutely worth it.

Check out the latest tech before you leave. Before I left for Europe skype was a terrific find. This made communication with family and the office very easy. This however was nearly obsolete six months the later during the trip to Australia and Asia. At that time a very reasonably priced international roaming plan for the I-phone was terrific. I would imagine the combination of skype and phone will be optimal in the future. Check before you leave as this evolves monthly.

My travel:

Europe, spring, 2009

The primary goal for my spring trip of James IVth was to visit the major pancreatic centers in Europe. I decided to visit Claudio Bassi in Verona, Pierre Clavien in Zurich, Markus Buechler in Heidelberg, and James Garden in Edinburgh. Secondary objectives included attending and presenting at the European Surgical Association, and having my family (wife and three children) meet me in Edinburgh at the conclusion of the trip.

Verona

University of Verona, Department of Surgery is organized into separate hepatobiliary and pancreatic units. The pancreatic unit is lead by Drs Pederzoli and Bassi, and is currently staffed by three other very active pancreatic surgeons (Falconi, Salvia, and Crippa). Dr. Bassi was a very gracious host and made sure that I enjoyed both the hospital and the city. The Verona group is renowned for their academic achievements which include significant leadership in the ESPAC trials. This group was extremely kind and welcoming and the opportunities to see the daily routine were excellent. Morning and afternoon rounds, operating room, and the clinical research structure were all made available. This is a very well-run unit and I would highly recommend any future travelers with a pancreatic focus to visit this institution.

Verona is a beautiful city and has amazing Roman architecture in the city center. The town is easily accessible and easy to manage. I stayed in the Hotel Sirhos which is next to the hospital and very convenient.

Vienna

One of the suggestions Murray Brennan made before my trip was to try to attend one of the major European or Australian meetings. I submitted an abstract to The European Surgical Association and presented these data there. The meeting was very interesting, many excellent abstracts presented, and I gained an appreciation for the high level of surgical research being performed in European centers. This also allowed me to gain an appreciation for the community of European surgery.

Zurich

Dr Clavien has built an extremely successful HPB unit in Zurich. It has a mix of both American and European structure, and seems to choose the best from both. Stephan Breitenstein was my primary host and was very welcoming. Stephan had also presented at the European Surgical and he was kind enough to introduce himself there and we made plans for the Zurich visit. The clinical practice in this group is HPB with a wide mix between liver and pancreas and liver transplant. The general surgical residents were very eager to share clinical and research experience and we had multiple occasions to discuss research efforts. There were also multiple teaching conferences to attend. I spent time with Stephan Breitenstein in the outpatient clinic and on rounds, and have ample opportunity to discuss similarities differences between our groups.

The city of Zurich is easy to manage and very accessible. I stayed in the Hotel Florhof which is walking distance to both the University and the city center. I arrived in Zurich on a Sunday morning and later in the afternoon took a train 20 minutes to the countryside to the town of Zug to meet friends who moved there from NYC. The town of Zug sits on a lake at the base of mountains. Amazing scenery.

Heidelberg

You cannot be a pancreatic surgeon and not visit Heidelberg. Dr Buechler has built an extremely busy unit where multiple pancreatic and liver resections are performed almost daily. The group of surgeons in Heidelberg is very busy and very focused on pancreatic and liver resection. Juergen Weitz performed his clinical fellowship with me at MSKCC and served as my host. It was great to meet up with an old friend and see him in his own environment.

I stayed in the Marriott hotel which is just across the Neckar River from the University — easy walking distance. The old city is easily accessible and very interesting. Juergen insisted on dinner in a “traditional German” restaurant where we had saumagan — stuffed pig stomach — which technically didn’­t violate the “you can’­t eat what you operated on that day” rule but may have violated the “you should never put another’­s stomach in your own stomach” rule.

Edinburgh

Edinburgh is a must see.

Prof Garden is a terrific host, his group with Rowan Parks and Stephen Wigmore are very welcoming and engaged, the multi-disciplinary group is delivering state-of-the-art care in a national system that is establishing effective ways of communicating between institutions, and the city itself is steeped in history. The “new” Royal Infirmary is located outside of town and is an integrated clinical and research facility. The Department is very well organized and rounds with Professor Garden and the team are a highlight.

The city was very interesting and my wife and children joined me there. We rented an apartment (found on VRBO) which was centrally located and very easy. The castles and lore of Edinburgh and the surrounding areas are just perfect for three boys around the age of 10. Professor Garden arranged very pleasant evenings with Stephen Wigmore, some of the other attendings, and residents.

On my final day in Edinburgh I was scheduled to see Ross Carter and Colin McKay at the Royal Infirmary in Glasgow. This hospital is an enormous old structure that has the feel of some of the older large public hospitals in America. Ross and Colin are extremely busy and have the difficult task of managing acute pancreatitis. They have been extremely innovative, with limited resources, and do a remarkable job with an extremely sick patient population. I think after a month or two with Ross or Colin a surgical trainee would be well equipped to deal with the challenges of this process. I would highly recommend a trip to see Glasgow as Ross and Colin are extremely engaging and their challenges at the Royal Infirmary are significant.

Australia, fall, 2009

Sydney

I left New York on a Friday night after office hours in the middle of November, rain and 50∞F. I arrived in Sydney on a Sunday, sun and 104∞F. Fortunately my primary host in Sydney was Phil Crowe. He picked me up at the hotel (Sir Stamford at Circular Quay), told me to get some shorts on, and we went to the beach with his wife and daughter. After swimming in the surf we went to a local restaurant for fish and chips and a beer. Phil was a terrific host and put me in contact with David Storey at the Prince Alfred Hospital as well as Phil Truskett at the Prince of Wales. I spent an additional day with Andrew Biankin at the Garvin Institute where he provided me a detailed tour and description of their work in tissue markers and clinical trials in pancreatic cancer. One evening was spent at the Prince of Wales with the surgical residents and general surgical attendings where we discussed management of IPMN. The residents were very engaged and the discussion was excellent.

Sydney is a wonderful city and it was great to stay downtown on the water. This is not easy access to the hospitals but taxi service is readily available. Phil Truskett organized an enjoyable dinner at a local restaurant with great Australian and New Zealand wine.

Melbourne

The travel between Sydney, Melbourne, and Brisbane was quite easy. There are commuter flights on the hour and the flights are short and comfortable. My time in Melbourne was made even more enjoyable as my wife’­s family (aunt/uncle/cousins) lives there and it was great to meet up with them. My primary hosts in Melbourne were Ben Thomson at the Peter MacCallum Cancer Center and Professor Chris Christophi at Austin Health. At the Austin I spent a thorough day with residents and surgeons discussing research, visiting the operating suites, and presenting on cystic lesions of the pancreas. We then re-grouped in the evening for a Greek dinner in the city which was a Prof Christophi favorite and a great deal of fun.

Brisbane

My visit in Brisbane was made very enjoyable by Andrew Barbour. Andrew also performed a fellowship at MSKCC, is a friend, and went to great lengths to make my trip worthwhile. I arrived on a Sunday afternoon and in the evening we had dinner at Professor David Gotley’­s house which sits on a hillside overlooking the city. Professor Gotley’­s wife and family were very gracious and we discussed many of the similarities and differences in medicine and culture between the U.S. and Australia.

The next several days were spent between the institutions in Brisbane that perform most of the HPB surgery, the Wesley, the Princess Alexandra and the Royal. Like the other cities in Australia the centers that treat patients are throughout the city however the group of surgeons interested in the diseases seem to work together rather closely. I spent a day in the operating room with Ian Martin who has a very busy HPB practice and later we met for dinner with other UGI surgeons such as Nick O’­Rourke, Bernard Smithers, and Leslie Nathanson. This dinner included a spirited discussion regarding the management of malignant and pre-malignant lesions of the pancreas.

Hong Kong

Hong Kong was the final leg of the trip. I arrived late at night, and had reservations at the Cyberport hotel near Queen Mary’­s Hospital. Professor Wong and Ronnie Poon were very gracious hosts. I spent time both in the hospital, operating suites, and discussing research interests with the surgical laboratory. Queen Mary’­s is a very large facility with cutting edge research and treatment in hepatitis and hepatoma.

Hong Kong is an amazing city, and similar in scale to Manhattan. I was able to enjoy the city with recommendations from Ronnie Poon. Professor Wong was extremely gracious and took time to discuss the current efforts at Queen Mary’­s and graciously escorted me to lunch at the Hong Kong Club. Ronnie also had arranged a dinner on Victoria Peak overlooking the city with spectacular night views of the city and harbor.

In conclusion, the James IVth experience was well worth the effort. The effort is not only on the part of the traveler but also the host. I can say that during my travel every single host made substantial efforts to make their institution and department available to me, to establish opportunities for discussion, and to expose me to their city and culture. I would like to thank everyone who made this trip a valuable experience. I would strongly recommend this experience to surgeons who would like to meet and exchange with their counterparts in Europe and Asia.

Peter J. Allen, MD
Associate Professor of Surgery
Memorial Sloan-Kettering Cancer Center
New York, NY.