Bradley N. Reames, MD, MS, FACS

Novel and innovative study of Second Surgical Opinions for #PDAC by @AEjaz85 @jcloydmd et al, with a nice accompanying editorial (I may be biased). bit.ly/SSOPDAC bit.ly/SSOeditorial bit.ly/ssoPDACpress @acsJACS @AmCollSurgeons

"Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life." In #APieceofMyMind, a psychiatrist and residency program director reflects on an unexpected #LungCancer diagnosis. ja.ma/48OxHxC

Tonight, the University of Michigan will play for its first national title berth since 3 days ago.

🩻Contrast-induced AKI: one of the biggest myths still shaping clinical decisions For decades we were taught: 👉 “Contrast damages the kidneys” 👉 “Avoid CT with contrast in CKD” 👉 “Hydrate, protect, delay imaging if needed” But what if… most of this is wrong?🤔 ->The uncomfortable reality Modern evidence shows: 👉 Low-osmolar contrast rarely causes true nephrotoxicity 👉 Even in CKD, AKI, and ICU patients 👉 The risk is often overestimated—or nonexistent So where did the fear come from? 📍 1950s high-osmolar contrast (actually toxic) 📍 Poorly controlled observational studies 📍 “Creatinine rise = contrast injury” assumption 👉 Correlation became causation 👉 And the dogma stayed ⚠️What recent data tells us ✔ No difference in AKI rates with vs without contrast ✔ No benefit from bicarbonate, NAC, or aggressive hydration ✔ Even ICU and AKI patients show no worsening outcomes ->Translation to real life 👉 The patient was going to develop AKI anyway...Not because of contrast!! ->The real problem: “Renalism” 👉 Avoiding necessary imaging 👉 Delaying diagnosis 👉 Choosing inferior tests And that leads to: ❌ Missed PE ❌ Delayed sepsis source control ❌ Worse outcomes ->Clinical mindset shift Instead of asking: 👉 “Will contrast harm the kidneys?” We should ask: 👉 “Will NOT doing the scan harm the patient?” ->Who still deserves caution? ✔ eGFR <30 ✔ Severe hemodynamic instability ✔ Multiple nephrotoxins Even then: 👉 Optimize volume 👉 Minimize dose 👉 Don’t delay critical imaging 🤓Bottom line ✔ Contrast nephrotoxicity exists… but is rare ✔ The fear is bigger than the risk ✔ The harm of NOT imaging is often greater In critical care 👉 We don’t treat creatinine 👉 We treat patients And sometimes… 👉 The most dangerous thing is NOT the contrast 👉 It’s hesitation. 📃Reference Florens N, Demiselle J. Kidney360 7: 445–449, 2026. doi: doi.org/10.34067/KID.0…

RUN TOWARDS YOUR COMPLICATIONS M&M isn't just a conference; it’s where surgical identity is shaped. From the "post-complication fog" to the podium, we discuss how to model humility, identify cognitive traps, and turn the most harrowing mistakes into collective learning. Join @georgoff @Cody_Mullens @BinghamMd for A Practical Guide to Presenting Complications ➡️ app.behindtheknife.org/podcast/master…

Congrats Dr. Greg Stettler !! @WakeACS

Congratulations @emakris_md and team on your award! @AHPBA, @WakeSurgonc

On this day 30 years ago, Mike Legg pulled off the move that changed hockey forever - the goal now known as “The Michigan”

🎉 Happy #MatchDay! Thrilled to welcome our newest Surgery residents to Wake! Let’s do great things together. 💛🖤 #Match2026 @WakeMis @WakeSurgonc @WakeACS @wfsomsig

February Issue: Impact of Different Primary Treatment Strategies on Recurrence-Focused Treatment of #PancreaticDuctalAdenocarcinoma @VincGroot rdcu.be/e3l8M @jhatjhmi1 @SyedAAhmad5 @SocSurgOnc

A young student once asked a wise monk, "Master, how do I stop taking everything so personally?" The monk smiled and said...

I’m often asked about port placement for different cases, but the principle is actually very simple. Position the camera about 20 cm from the target anatomy—whether that’s the gallbladder, appendix, liver, pancreas, uterus, or anything else. Then place the remaining trocars roughly 8 cm apart. I personally prefer having two “right arms,” with the camera in port 2, but that’s just preference. You can just as easily put the camera in port 3 and work with two left hands—it really doesn’t matter much. This approach works for essentially any case. The example shown is for the upper abdomen. If your target is in the lower abdomen, simply flip the image upside down; if it’s lateral, rotate it sideways 😃 @IntuitiveSurg #roboticsurgery

Valuable information from the NO-CUT Trial -179 patients received induction TNT (4 cycles CAPOX-->LCCRT), 25 (14%) excluded during tx. -----60% of these cancers were mid-rectal -----18% were T4, and 54% were T2 -12 weeks later, restaging (n=154) showed cCR in 10.5% -Pts with near-cCR were given another 4-5 weeks, then restaging found a cCR in an additional 20% (so 30.5% cCR overall). -----T4 tumors had a 6% rate of cCR -----N2 tumors had a 16% rate of cCR -----Mid-rectal tumors had a 19% rate of cCR -----Distal rectal tumors had a 36% rate of cCR -The incomplete responders got TME, of which only 10 (8%) had pCR on final path. ----Of the 10 pCRs, 3 had recurrence (1 local, 1 distant, 1 both) which is high. For watch-and-wait (n=47), regrowth occurred in 7 patients (15%), all of which had salvage TME, and 1 of which (14%) developed distant metastasis after this. Tumor-agnostic ctDNA was drawn at baseline and then 11-17 weeks after TNT. ---95% of patients were ctDNA+ at baseline ---24% were ctDNA+ after TNT (8% of cCRs and 33% of incomplete responses) Of the 3 patients with cCR despite being ctDNA+ after TNT, 1 had local recurrence, 1 had distant recurrence, and the 3rd transition to being ctDNA negative 5 weeks later and did well. What does this mean (to the select few still reading)? -With induction TNT, you have to be patient, as cCRs take more time (only 34% of cCRs present 12 weeks after TNT). -Mid-rectal cancers may not be as responsive to TNT as distal cancers. -When you include T4 and N2 patients in your protocol (excluded from some other studies), the cCR rate goes down, and the overall cohort does a bit worse. -If the patient is ctDNA+ after TNT, even in the presence of a cCR, surgery is probably best, but this remains uncertain since the numbers are small. sciencedirect.com/science/articl…

Is minimally invasive (robot) #Whipple surgery just as safe as open surgery? Today: #DIPLOMA2 RCT in @NEJMEvidence ➡️ evidence.nejm.org/doi/full/10.10… 288 patients, 14 expert centers, 6 countries 🇳🇱🇮🇹🇩🇪🇧🇪🇪🇸🇸🇪): MIS equally safe as open in experienced centers. With faster recovery, fewer wound complications, less pancreatic fistula, and a shorter hospital stay. @nine_degraaf @AnoukEmmen @Abuhilal9Abu @e_mips @EAHPBA

Hot from the press 🔥🔥🔥 "The @EAHPBA - @ESSOnews - Innsbruck consensus recommendations on peri- and postoperative management following liver resection" out now @hpbjournal. Happy to be able to contribute my small share in this! authors.elsevier.com/sd/article/S13…

Surgery-specific antimicrobial stewardship programs with personalized antibiotic strategies represent a promising approach to minimizing infection risk while combating antibiotic resistance in procedures such as pancreatoduodenectomy. journals.lww.com/annalsofsurger…

Bingeing TikTok reels may be hazardous to your well-being. 71 studies, >98k people: The more short-form videos teens and adults watched, the more they struggled with attention, self-control, and stress and anxiety. Read a book. Watch a movie. Long live longform.

Dr Bartlett’s obituary today in the @nytimes: “Robert H. Bartlett, Father of Innovative Life-Support System, Dies at 86”nytimes.com/2025/11/08/sci… via @NYTimes

Have you opened @SWOG 2408 evaluating Lanreotide for preventing POPF? @ShamSurgery @FlavioRochaMD

Endoscopic or surgical #gastroenterostomy for palliation malignant gastric outlet obstruction? 🚀Today @LancetGastroHep: #ENDURO randomised multicenter trial @DPCG_official 🇳🇱 Excellent nationwide collaboration #surgery & #gastroenterology 🙌 ⏩️ sciencedirect.com/science/articl…

Congratulations and Welcome to Wake Forest to our Surgical Critical Care Fellows Class of 2028! We are excited you matched with us! @WakeACS