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Video: I Am A Simple Surgeon: A Living Legend Of The World Coloproctology About Myself And My Work
"I am a simple surgeon": a living legend of the world coloproctology about myself and my work
In early June, the Russian School of Colorectal Surgery celebrated its tenth anniversary. The most titled British coloproctologist, who developed and introduced around the world a fundamentally new method of surgical treatment of rectal cancer, Bill Heald, took part in a large-scale scientific forum. The patriarch of world coloproctology gave a short interview to Mednews.
Photo: Irina Reznik /
In early June, the Russian School of Colorectal Surgery celebrated its tenth anniversary. The founder of the national training center Pelican Bill Heald, the most titled British coloproctologist, who has developed and introduced around the world a fundamentally new method of surgical treatment of rectal cancer - total mesorectumectomy, took part in a large-scale scientific forum. The patriarch of world coloproctology gave a short interview to Mednews.
Ten years ago, you first came to Russia, where you performed an operation, and more than two thousand people gathered to watch it “live”. And this moment became the birth of the RSHKH project. What has changed since then?
- From the very beginning, it was a wonderful school and practice for coloproctologists from all over the world. The school is constantly evolving, and that's great. And, of course, this is the achievement of Pyotr Tsarkov (chairman of the ROKCH, director of the Clinic for Coloproctology and Minimally Invasive Surgery at Sechenov University) and his team.
Colorectal cancer is a very good model to demonstrate how a patient can be completely cured by surgery. Unlike a number of other malignant tumors, which still remain fatal diseases. And if you train specialists correctly, as the Russian School of Colorectal Surgery does, then, thanks to surgery, it will be possible to achieve a cure of two-thirds of patients.
And who did the older generation of surgeons study with?
- When I was young, I had a mentor who said: “Either get the maximum result, or don't take on the operation at all. You have to make sure that you are doing everything as well as possible. " I started out as a general surgeon, and urgently operated on a man in a traffic accident. It was not possible to save him, and I will never forget the conversation with his wife. She asked, "Do you think you were the right surgeon for my husband?" And I replied that I have been asking myself this question since the patient's death.
The fact that colorectal cancer surgery has risen to such a height is largely your merit. Indeed, it is thanks to your technique of total mesorectumectomy that the frequency of recurrence of rectal cancer has radically decreased
- Of course, I am proud to be the author of this idea. And I am glad that many people today are doing the operation I invented better than myself. I see this at the Russian School of Colorectal Surgery. And then, many years ago, I kept thinking about the causes of these relapses, trying to understand how cancer behaves. And I came to the conclusion that the treatment should be based on embryology. Cancer remains for a long time within the embryological layer - the sacred layer of coloproctology. And this idea is even bigger than I imagined then.
But your story is also an example of how difficult it is to prove yourself right …
“At that time, half of the cancer was growing in the pelvic region, and even in the best Royal Hospital, many people died from local relapse. And when I spoke about 137 clinical cases with 3% relapses in a small town clinic, I was accused of lying. That I deliberately underestimate the recurrence rate in my patients. And later I was severely humiliated at a conference of oncologists in the United States, when a recognized authority in this area said: "never believe those who say that a new technique is changing the situation." The first to believe in the new method was in Sweden, where I began to conduct my master classes. And total mesorectumectomy quickly proved to be effective in the treatment of rectal cancer.
It is not easy to promote something new and unusual even now. It is not the first year that a heated debate has been going on at this conference about the need to perform lateral lymphadenectomy in rectal cancer. How do you feel about this Eastern methodology, is the West ready to accept it?
- Disputes between Eastern and Western surgeons have continued throughout my life. In disputes, truth is born, and it's good that we constantly discuss such moments. I believe that the "Eastern" approach can be used, but for a specific narrow group of patients - who have lymph node involvement. Lateral lymph node dissection is a difficult operation that can be complicated by impaired bowel function. And Western surgeons are convinced that for the initial stages, it is enough to perform a total mesorectumectomy. But the positions are gradually converging. And, for example, yesterday Petr Tsarkov demonstrated excellent lateral lymphadenectomy. He does an excellent job and tries to heal every patient possible with this method.
But while this technique is not included in the Western guidelines, how difficult is it to apply to surgeons wishing to develop the Eastern technique? For our country, such questions are also becoming relevant, because at the state level a law has been adopted on the compulsory adherence to clinical guidelines
- Such laws exist not only in Russia, and for surgeons every day this problem is becoming more difficult. State restrictions do not favor the development of surgery. And rules that tighten the working environment can be bad for innovation. Even with the rationale behind such an operation, proposing something new, you cannot know for sure that it will help. And since you are limited, you are forced to do what you have been doing from time immemorial, and not develop. In such situations, we are saved by the patient's informed consent, which he can give to the use of a new technique.
And, of course, such complex operations as, for example, lateral lymph node dissection should be performed in specialized institutions, where there are sufficiently well trained surgeons for this.
How specialized should colorectal cancer treatment be?
- I believe that each district, where more than half a million people live, should have its own coloproctology center. On the territory where from a quarter to half a million people live, a small hospital is enough, which has a coloproctological team. It is advisable to carry out most of the coloproctological operations here. But certain, very rare operations can only be carried out in a small number of specialized departments in the country.
You have lived a happy but very difficult life. Have you ever thought of leaving the profession?
- Not. There was a desire to become better in this profession. Many people do not understand how I can have fun doing coloproctology, cancer. I am a simple surgeon and all my life I follow my idea, which my mother laid in me. She was a very wise woman and told me that being a doctor is the best way to live life. This job allows you to get to know people like no other. For me, the operating room is the happiest place on earth. I love anatomy and enjoy watching operations, each time admiring the way God created us.
Are you a believer?
- Yes, I believe in God. The human body is so beautiful that it could not have arisen by itself.