Charles Friel

@UVASurgery @MedicineUVA @uvahealthnews Thrilled by this group. Going to be a great year!

Happy Match Day!!! We are thrilled to welcome twelve STELLAR new residents to the UVA Surgery family.. Congratulations to our incoming class -- we can’t wait to see all you’ll accomplish here at UVA! 🎉🧡💙 #Match2026 @MedicineUVA @uvahealthnews

@jbcarmody Interesting. I applied 1989. All time low. Everyone wanted to go to Wall Street. But the bottom fell out and med school picked back up. Your point is well taken.

Applications to medical school were up 4-5% vs. last year. But when you look at long-term trends, medical school applicant numbers behave like a counter-cyclical asset with a delay. So how much of this represents optimism about medicine - vs. skepticism about the alternatives?

@SeanLangenfeld @SurgEndosc @MSKCancerCenter @JohnRTMonsonMD @DrGarciaAguilar @R_Perez_MD @ASCRS_1 @Averywalker21 @escp_tweets @ianmpaquette @SWexner Agreed…what it also reminds us is endoscopy by far the most important part of surveillance and if it’s abnormal you should take it out. Over 90% have cancer.

Interesting @SurgEndosc study from @MSKCancerCenter looking at patterns and detection of local regrowth in patients with rectal cancer who experience cCR after TNT and undergo watch-and-wait (2006-2020) -Suspected local regrowth occurred in 30% -Abnormal MRI with normal endoscopy was uncommon (11% of suspected regrowths) compared to Normal MRI/abnormal endoscopy (32%) and abnormalities on both MRI and endoscopy (57%) -For patients undergoing salvage surgery, the rate of pCR was 44% in the +MRI/-Endo group, 18% for the -MRI/+Endo group, and 4% for the +MRI/+Endo group. This means residual/recurrent cancer was much more likely to be present in the final specimen if the endoscopy was abnormal. -Of the 99 patients with salvage surgery and recurrent cancer on final pathology, only 1 patient (1%) had this recurrence detected by MRI alone. Important caveats: -This study goes back to 2006, and MRIs have certainly evolved during that time (as have TNT, surveillance, etc). -All false positive MRI findings occurred after 2013, suggesting newer MRIs pick up subtle abnormalities that aren't necessarily cancer regrowth. -pCR on final pathology shouldn't necessarily be considered a failure in management. These patients do very well. What I take home from this study is that isolated irregularities on surveillance MRI can be safely monitored without proctectomy in the short-term...ie you can leave the rectum in for a little while and let the problem declare itself. pubmed.ncbi.nlm.nih.gov/40659952/

Farewell my friend. You have been an inspiration for many of us @UVASurgery and @uvamedicine @UVAMedAlum You will be missed. Peace dignitymemorial.com/obituaries/cha…

@HassanRHashmiMD @GaertnerWB @ASCRS_1 @SWexner @juliomayol @JohnRTMonsonMD @SeanLangenfeld @DbsDiff @SAGES_Updates Until it leaks several days later…because the “perfect ones” seem to be the ones that leak….😂😂😂 (sorry, couldn’t resist 😉😉)

@GaertnerWB @ASCRS_1 @SWexner @juliomayol @JohnRTMonsonMD @SeanLangenfeld @DbsDiff @SAGES_Updates Annoyance: Wrestling with small bowel that just won’t stay out of the way. Delight: That moment during the leak test when the anastomosis looks pristine: no leak, well-perfused, patent. Always satisfying on flex sig.

What is your biggest annoyance or delight of laparoscopic colectomy? @ASCRS_1 @SWexner @juliomayol @JohnRTMonsonMD @SeanLangenfeld @DbsDiff @SAGES_Updates

@MarviTariq @herbchen @UABSurgery @womeninsurgery @uabctsresidency @CozetteKale @shao_connie @MarySmithsonMD @NikitaWadhwani_ @BownesLaura @PeterAbraham92 It’s a great day. Congratulations

Last day as a @UABSurgery resident. Thanks for carving surgeons out of us @herbchen @UABSurgery @womeninsurgery #ilooklikeasurgeon @uabctsresidency

@tarik_sammour @JohnRTMonsonMD Agreed. These organ preservation numbers are low.

@JohnRTMonsonMD TNT should double those rates.

Nationwide analysis on the role of neoadjuvant radiotherapy and watch and wait in rectal cancer - European Journal of Surgical Oncology ejso.com/article/S0748-…

@JBMatthews @UChicago @UChiPritzker Fun….Congrats……not happening here. “You work too hard” is all I heard….😂😂😂

What a special privilege to be able to hood my son who is completing his MD-PhD. Biological Sciences Division Academic Ceremony today at @UChicago @UChiPritzker Rockefeller Chapel.

@AjthorsenL @justinmaykel @AnnLowry12 @ClaireSokas @shreyaguptaMD @mikavarma @mncolonrectal @UMNSurgery It was loads of fun

MN dinner 2025- so many to catch up with! ⁦@justinmaykel⁩ ⁦@AnnLowry12⁩ ⁦@ClaireSokas⁩ ⁦@shreyaguptaMD⁩ ⁦@cmf2x⁩ ⁦@mikavarma⁩ ⁦@mncolonrectal⁩ ⁦@UMNSurgery⁩

@BoLovvorn @alicialeubanks @KidsAtColumbia @UVASurgery @APSASurgeons They sure did. 👏👏👏😄😄😄

🥂 & a 👊 to @alicialeubanks who matched in Pediatric Surgery @KidsAtColumbia ! 💥 Columbia got LUCKY, lemme tell ya! @UVASurgery @APSASurgeons

@DCRjournal @SoniaRamMD @justinmaykel @changtangMD @luciacolorectal @deanlute @juliomayol @drjamestaylor @KarasJoshua @MaloneyNell @Averywalker21 You can’t have one without the other. Just like in sports. A star player (quality) is only a star if available (ie not hurt =access)

#DCRJournal Real World Questions What do you think? Reply & let's discuss! @SoniaRamMD @justinmaykel @changtangMD @luciacolorectal @deanlute @juliomayol @drjamestaylor @KarasJoshua @MaloneyNell @Averywalker21

It’s our 24th Annual Resident Research Day. Just reminds me that our @UVASurgery residents are wicked smaarht! (For all the Bostonians out there)

@HansL16 @SWexner @AldosariSarah2 @PipeCabreraV @GianlucaPellino @pferrada1 @juliomayol @TomVargheseJr @CiruAndes2 That is fair. Bias is probably the wrong word. This is work we did that suggests that leaving wounds open may decrease infections but might actually be more resource intensive and more costly. It really depends on the severity of infection. Not all “infections” are equivalent.

@cmf2x @SWexner @AldosariSarah2 @PipeCabreraV @GianlucaPellino @pferrada1 @juliomayol @TomVargheseJr @CiruAndes2 Good point, there are afaik no PROMS in this area. But this isn’t necessarily bias. Your suggestion that lower infections are an artifact of the technique oversimplifies the outcome, as drainage is a deliberate design choice, not a flaw in study methodology.

How to close the stoma skin after stoma reversal surgery: Circular (purse-string) vs primary skin closure! Systematic review and meta analysis by @GianlucaPellino et al! @pferrada1 @SWexner @juliomayol @TomVargheseJr @CiruAndes2

@Averywalker21 @SWexner @AldosariSarah2 @PipeCabreraV @GianlucaPellino @pferrada1 @juliomayol @TomVargheseJr @CiruAndes2 Not if the treatment is opening wound. These “infections” are minor & treatment is to open. That is the morbidity. If you leave them all open then 100% experience the morbidity. It’s only that we measure infections it feels bad. If we measured open wounds conclusion is different

@cmf2x @SWexner @AldosariSarah2 @PipeCabreraV @GianlucaPellino @pferrada1 @juliomayol @TomVargheseJr @CiruAndes2 What would be better care? Decreasing the risk of infection sounds pretty good, no?

@AldosariSarah2 @PipeCabreraV @GianlucaPellino @pferrada1 @SWexner @juliomayol @TomVargheseJr @CiruAndes2 Disagree. “Infection” isn’t necessarily the end point to measure. It’s the consequences patients dread. If I leave all wounds open and pack them I may not have any infections. But it’s not better care. If we measure time to closure it would be longer for the purse string

@cmf2x @PipeCabreraV @GianlucaPellino @pferrada1 @SWexner @juliomayol @TomVargheseJr @CiruAndes2 But isn’t that exactly the point? If part of the purse-string technique is leaving a small opening for drainage and packing, and that leads to lower SSI, then it’s not bias, it’s just better technique supported by outcomes.

@SWexner Is this surprising? People with chronic symptoms do better. Seems like this is what we mean by “individualizing” treatment.

The pendulum continues to swing

@UVASurgery @MedicineUVA @allantsung Very excited for this group of exceptional people to start residency. #HoosUVASurgery

We are thrilled to welcome 13 incredible new interns to UVA Surgery! This group is talented, driven, and ready to make their mark. We can’t wait to see what the future holds with them on our team. 😃 #Match2025 #MatchDay2025 @MedicineUVA

@LindaMThoracic @UVA_TCV_Surgery @PhilipCarrott @vz_surgery @UVASurgery Did you catch the end? I had to leave after they tied it up to get my car out of JPJ lot by 4:30 pm…🤬🤬. Started at the LAX game. Tough loss there.

The @UVA_TCV_Surgery🫀🫁 team cheered on Hoos ⚾️ team to an exciting victory! Teamwork makes the dream work!

@JohnRTMonsonMD @Neil_J_Smart Nothing new really. Local recurrence about what has been reported with any version of local excision. It’s a compromise…but something to consider in older, frail patients. The “glass half full” camp might say 70% did well. Which might be pretty good if patient very frail

No offense, but this paper has many flaws to read at your peril! @Neil_J_Smart Risk of recurrence following transanal endoscopic microsurgery without neoadjuvant or adjuvant treatment in T2 rectal cancer - European Journal of Surgical Oncology ejso.com/article/S0748-…