Recently, InsideSurgery had a chance to speak with Dr. Charles J. Yeo about his career as a top Whipple and pancreas surgeon and his ongoing role as a surgical leader and educator.
As the Samuel D. Gross Professor of Surgery and Chair of the Department of Surgery, you welcomed your second intern class to Thomas Jefferson University in Philadelphia, Pennsylvania last month. What one piece advice do you have for your new trainees?
One piece of adviceâ€¦.thatâ€™s tough! Several pieces of adviceâ€¦.enjoy the challenges and experiences of internship; read and increase your knowledge base outside of that 80 hours; practice knot tying skills; practice suturing skills; practice laparoscopy skills and focus on level one evidence.
You are a graduate of Princeton University and recommend that your interns read famed Princeton basketball coach Pete Carrilâ€™s book THE SMART TAKE FROM THE STRONG. Why do you think a book about basketball pertains to learning surgery?
I think itâ€™s important that surgical interns recognize that they are training for their career-long profession, which if they do it right, will be highly successful. Practice is important. Striving to be the best is important. Paying attention to detail and doing every little thing correctly are quite important.
Why do you think Coach Carril is such a good basketball coach?
That is a tough question. I think if you read Coach Carrilâ€™s book â€œThe Smart Take from the Strongâ€, youâ€™ll get a good sense of the Coach, his life philosophy, and his basketball philosophy.
Letâ€™s face it, Coach Carril was able to take some very skilled basketball players, who probably would not have accomplished as much with individual effort, and mold them into terrific teams. His teams won numerous Ivy League championships, won the NIT Tournament in 1975, and nearly beat Georgetown in a 16 seed versus 1 seed game (50 to 49 loss where the refs failed to put Kit Mueller on the foul line after he was fouled by Alonzo Morning with no time remaining).
In his next to last game at Princeton, Coach led a 13 seed Princeton team to victory over the fourth seed defending champ UCLA team by a score of 43 to 41 on a backdoor lay-up by Gabe Lwellis. Coach was such a good basketball coach because he understood his players, he mandated the team concept, he was never afraid to criticize you for doing the wrong thing, and always wanted you to perform at your very best! He was a perfectionist!
If you look near the end of Coach Carrilâ€™s book mentioned above, youâ€™ll see a list of 25 â€œlittle things to rememberâ€. These little things apply to basketball, but many also apply to life.
Why did you attend Princeton and not Harvard, Yale, Columbia and particularly Penn (another Ivy League power basketball school)?
My decision to go to Princeton was really quite easy. I watched Bill Bradley in the mid sixties on television perform wonders with the basketball, and I simply wanted to be the next Bill Bradley at Princeton. Oneâ€™s hopes are never entirely achieved! I never applied to Harvard, got accepted into Yale, Columbia and Penn, but Princeton was clearly my first love
Were you a sports star in high school?
I went to high school at Spring Valley Senior High School in Spring Valley, New York. I was there from 1969 to 1971, as it was a three-year school. During that time, I played basketball on the junior varsity my sophomore year, and on the varsity in my junior and senior years.
In addition, I played soccer. We had a top notch basketball team, but only a fair soccer team. My senior year we did win, for the first time in school history, a section 9 basketball game, which we were very much the underdogs in, against a very good team from Kingston, New York. I remember having a remarkably good game which was unusual for me, scoring 24 points, and leading us to a 4 point victory.
Following that, during my senior year, I did get some recruitment letters, most notably from the University of Richmond and Worchester Polytechnic Institute. However, my dream was to be the next Bill Bradley at Princeton, and so thatâ€™s the school that I attended.
How did your basketball career at Princeton turn out?
At Princeton, it was immediately clear to me that I was never going to be a basketball star. I failed to grow past 6â€™ 2â€ and my freshmen friends who became members of the freshmen team were far better basketball players than I would ever be. I continued to support them for all four years, and I played an awful lot of intramural basketball, pick-up basketball games, and squash.
What other sports did you play at Princeton?
After trying out for both freshman basketball and freshman soccer, and realizing that my playing time would be limited, I concentrated on my studies during my freshman year.
Thereafter, I became interested and was recruited to play rugby by various members of the Princeton Rugby Club. This was a non-varsity (club) sport, that practiced twice a week in both the spring and fall (Tuesdays and Thursdays) and typically had a match either on Saturday or Sunday of the weekend. This was a great opportunity to enjoy the camaraderie of others in sport, but still give me time to study and particularly to do the various laboratories that tended to take place on Monday and Wednesday afternoons as part of my science experience at Princeton. So, I was able to use my hand-eye coordination from basketball, and my foot skills from soccer on the rugby pitch!
What are your memories of Princeton?
Princeton was an absolutely awesome experience. The University sits in the most beautiful part of New Jersey, and is somewhat isolated from the beautiful town of Princeton. My classmates excelled with scholarly activity, athletics, and with extracurricular events. I would say I enjoyed the entire experience at Princeton, from the classroom, to the athletic pitch, to my friends, and to the social events.
The things that I remember being most troubled about at Princeton were the political unrest of the times (Vietnam War), the incredible amount of work, and my own personal desire to achieve academically so as to give me the best chance to go to the most competitive medical school possible.
Why did you go to Johns Hopkins Medical School?
My reasons for attending Hopkins Medical School were several. I had actually gotten into the University of Pennsylvania, and had a room assigned. I was also accepted to many other medical schools, but was put on the waiting list at Hopkins. I had never been put on the waiting list for anything before. When I got into Hopkins late in August of 1975, I quickly changed gears, and with the support of my parents decided to go to Hopkins, meet the challenge, and prove to them that I should have been admitted initially, and not from the waiting list.
At that time, Hopkins was higher rated than Penn, and I had had the incredible opportunity to interact with one of the Hopkins surgical faculty members, Dr. J. Alex Haller. Dr. Haller remains a friend, he was the Chief of the Division of Pediatric Surgery, and he was a national/internationally known surgical leader. I also had a chance to get to know Dr. Hallerâ€™s family. So, for both the challenge and personal reasons, I chose to go to Johns Hopkins.
Did you ever regret going to Johns Hopkins over Penn?
Never. I enjoyed Hopkins tremendously. It was the most difficult academic four years of my life. I worked hard, studied diligently, and was able to be a successful graduate, receiving the award given to the individual who achieves the highest clinical scores. In essence, I proved that taking me off the waiting list was the right thing to do.
After medical school at Hopkins you stayed on there to do your surgical residency. What did you like least about being a surgical resident at Hopkins?
Thatâ€™s really a very hard question. The Hopkins residency at the time (1979-1986) was incredibly demanding, challenging, time consuming, and difficult. Through it all, I received tremendous surgical training, and interacted with surgical leaders. I suppose the thing in retrospect that was most difficult was maintaining a personal life. We had no 80-hour work week, and in essence, our work week was 168 hours long. For many of our senior resident rotations, we were on call 24/7, with absolutely no time away. We worked hard, did tremendous cases, took care of challenging and difficult patients, but had very little time for our personal needs, family life, etc.
After you finished your training at Hopkins, you joined the faculty there. You were widely considered to be one of the best Whipple and pancreatic surgeons in the world, but you also did abdominal surgeries other than Whipple surgery including liver resections. Now that you are the chair of surgery at Jefferson, what would you like your clinical practice to be?
I think for my clinical practice here at Jefferson, itâ€™s best if I focus on those things that I do frequently, that I have a passion for, and that Iâ€™ve published on. So I think for me I should focus on hepato-pancreaticobiliary surgery, but not avoid doing gastric resections, or other upper abdominal work. We have tremendously talented surgeons here at Jefferson who perform esophageal resections, colorectal surgery, and other complex alimentary tract surgical procedures. One goal is to further promote our expertise in pancreas, biliary and other related cancers, and to formally recognize our expertise nationally in these complex HPB cases.
How many pancreas resections have you done in your career â€“ that is, pancreaticoduonetcomy (Whipple surgery), pylorus preserving pancreaticoduonetcomy (PPPD or miniWhipple) etc.?
I know for a fact I am approaching 800 pancreaticoduodenectomies, and have performed over 200 distal pancreatectomies. Mixed in there would be over 100 other operations on the pancreas, such as pancreatic debridements, enucleations, central pancreatectomy, pseudocyst drainages, etc.
In all, I know I have done over 1000 pancreatic operations, taken out well over 1,000 gallbladders, and have performed well over 1,000 bile duct anastomoses as part of the Whipple procedure, bile duct injury repairs, or palliative operations for cancer.
Even though you are widely regarded as one of the best pancreatic and Whipple surgeons, pancreatic cancer presents a difficult clinical challenge. When a patient comes into your office and says â€œDoc, I have a pancreatic cancer and I am told this is going to kill me,â€ what do you say to them?
Itâ€™s true that the common fear is that pancreatic cancer is a lethal disease. Fortunately, this is no longer true. With improvements in early detection, the move to operate on pre-malignant lesions, better imaging, more aggressive surgery, and advances in chemotherapy and radiation therapy, we are doing much better for patients with pancreatic cancer.
In fact, patients who are able to undergo resection for small tumors (less than 2 cm), without lymph node metastases, and where we can achieve negative margins, have at least a 40 percent five-year survival. This was unheard of 20 years ago! For tumors that are well differentiated, and for pre-malignant lesions, we do even better.
Additionally, our recent data show that for those individuals who survive five years post-resection, their subsequent five-year survival exceeds 50 percent, meaning that once you reach the five-year landmark, you have a better than even chance of living an additional five years. This is remarkable progress for a disease that at one time had many surgeons believing that a nihilistic approach was the best approach.
What specific areas in pancreas cancer research are you focusing on?
On the clinical front, we are focusing on randomized trials to evaluate the best method for performing pancreaticojejunostomy, the most appropriate means of closing the pancreatic stump after distal resection, and the use of alcohol celiac nerve block in patients with resected or un-resected pancreatic and related cancers.
On the bench research front, we have three laboratories in the Department of Surgery at Jefferson interested in studying pancreatic cancer. Dr. Susan Lanza-Jacoby is looking at various VEGF and EGF receptor inhibitors. Dr. Hwyda Arafat is looking at the renin-angiotensin system, its signal transduction mechanisms, and its role in pancreatic ductal adenocarcinoma. Dr. Jonathan Brody, our newest recruit and a genius molecular oncologist, is working on many projects including: the role of pp32 in pancreas cancer, the Fanconi anemia pathway in pancreas cancer, thymidylate synthase as a predictor of response to 5-FU chemotherapy, and other novel ideas.
Do you ever see yourself moving into a purely administrative role in medicine â€“ that is, Dean of a medical college or an even higher office?
No, not at this point, but one never knows.
How long do you plan on operating?
I hope to continue to operate as long as my skills remain intact, and I remain healthy and capable. At this point, Iâ€™m hoping for at least another 20 years!
Your wife Terry is a nurse practitioner â€“ do you talk about your cases at home?
Absolutely! In fact on one of our first dates, I actually drew, on a napkin, the anatomy of a Roux-en-Y hepaticojejunostomy! Terry was trained as a medical nurse, then as an acute care nurse practitioner, and has subsequently received her M.P.H. and then Ph.D. from the Bloomberg School of Public Health at Johns Hopkins.
We talk about many things at home. My children kid me and ask me, â€œwas the Whipple Barn open today, Dad?â€ So, yes, we do talk about the hospital at homeâ€¦cases, patients, administrative details, research findings, the whole gamut. Of course we also talk about our son Williamâ€™s activities, our daughter Katerinaâ€™s activities, as well as aspects of Terryâ€™s professional and personal life.
Where would you like to take your department at Jefferson in the next three years?
I think we have a great opportunity at Jefferson to bring the Department of Surgery to new heights. We have a very talented faculty, with many young and enthusiastic surgeons.
As the University and Hospital partner together to build the new Jefferson Ambulatory Building, we have a great chance to move the department to a service-line approach, and to be far more patient-centric, patient-friendly and efficient.
I see us growing the complex cases, not only in the alimentary tract arena, but in transplantation, cardiothoracic surgery, and trauma care, amongst others.
Fund raising is a great opportunity for us. Our new Development Officer, Lara Allan Goldstein has tremendous energy and skill, and I think will give us a chance to identify grateful patients, and benefactors who can further our mission. I think itâ€™s important that we fully endow several more Chairs, not only for people at the professorial level, but for newly recruited Assistant Professors with both clinical and research expertise, so as to give them salary support for several years to grow their research efforts.
Additionally, Iâ€™d like to see the administrative surgical floors populated in the next few years by industry-funded and NIH-funded investigators, focusing on our two current areas of expertise: endovascular biology and oncology.
Do you think NOTES is something youâ€™d like your department to get involved with?
Absolutely! NOTES is an interesting concept, which likely will not evolve exactly as we think at this point. However, the benefits of a scarless and non-anesthetic approach to intra-abdominal and perhaps even intra-thoracic surgery remain important. We have young talented minimally invasive surgeons, who can easily partner with our expert gastroenterologists/endoscopists, to gain experience in the NOTES technology.
What one surgeon (living or deceased) would you most like to operate with that you have never operated with?
For me, thatâ€™s an easy one. As the Samuel D. Gross Professor here at Jefferson, and as an incredible admirer of the Thomas Eakinsâ€™ painting, the â€œGross Clinicâ€, I would love to operate with Samuel D. Gross, particularly as part of that incredibly powerful painting.
Who is the best technical surgeon you have seen; that is, the surgeon with â€œThe Best Handsâ€?
That is really a very tough question. During my surgical residency, Dr. Hartzell Schaff, who is now a cardiac surgeon at the Mayo Clinic, impressed me as a technical wizard. Of course I was an intern at the time, but I really thought that Hartzell was a tremendous surgeon.
During my residency, I had a chance to operate with John Cameron, Mel Williams, Jim Sitzmann, Michael Zinner, Russell Postier, and many others. I learned from each of these individuals, various lessons regarding surgical skill, O.R. demeanor, and technique.
Iâ€™ve always heard it said that Denton Cooley had the best hands of all. I think itâ€™s important to recognize that the surgeon who has â€œthe best handsâ€ appears effortless at surgery, minimizes motions, remains completely focused on the task, and makes even the most challenging cases seem simple.
Who is the best overall surgeon in your opinion including technical skills, judgment, post-op management, and bedside manner?
For me thatâ€™s an easy answer. It would be the surgeon that has had the biggest influence on my career, the surgeon who was my Chairman for almost two decades, and the surgeon that stimulated me throughout my junior and senior faculty career.
That individual is John L. Cameron, the past Chairman of the Department of Surgery at Johns Hopkins, the past Halsted Professor, who remains an active surgeon at Johns Hopkins. No one taught me more about surgery, in or out of the operating room, than John Cameron.
Are any of your children planning on a career in surgery?
At this point, Iâ€™d have to say that remains to be seen. My son, William is 20, and will likely be a political science or history major at the University of California, Santa Barbara. At this point, he is not enthusiastic about a career in surgery.
Katerina, who is 14, is a fine student, a talented athlete, and an extraordinary musician. She has talked about a career in veterinary medicine, and as a youngster, wanted to be called â€œDr. Katerinaâ€.
What has been the biggest success or accomplishment in your medical career?
Iâ€™m really very proud of many things that I have accomplished in medicine and surgery. I was delighted to rise through the ranks at Hopkins, to obtain NIH funding, to mentor numerous surgical residents and laboratory fellows, and to be recognized as the first John L. Cameron, M.D. Professor for Alimentary Tract Diseases at Hopkins.
It was an absolute thrill and honor to be named the Samuel D. Gross Professor and Chairman of the Department of Surgery at Jefferson. Dr. Ward Griffin said one time many years ago at an Association for Academic Surgery Meeting, â€œyour children will never read your curriculum vitaeâ€. While my children may never read it, I feel very honored to have been given the opportunity to contribute over 350 articles to various journals, to write dozens and dozens of book chapters, and to have served as the Co-Editor (5th Edition) and now Editor-in-Chief of Shakelfordâ€™s Surgery of the Alimentary Tract (6th Edition).
What has been the biggest failure or disappointment in your medical career?
Iâ€™d have to answer that question on two levels. First, operating on a patient for an elective procedure and having them die post-operatively continues to bother me. I think a compassionate surgeon never gets over losing patients in the post-operative period, whether itâ€™s from something we as surgeons do, or whether itâ€™s from events largely out of our control such as a myocardial infarction, a pulmonary embolism, etc.
Second, I was disappointed years ago that I was unable to personally sustain a research laboratory and maintain my NIH funding. I think this partially relates to the changing parameters of science, and to the fact that my lab training occurred during the era right before molecular biology and molecular oncology.
Do you come from a â€œmedical familyâ€?
In my own family, the answer would be no. On my fatherâ€™s side, neither he nor any of his siblings went to college. On my motherâ€™s side, we had one physical therapist, and a college educated engineer.
My brother spent many years in the Navy, worked as a police officer, and then gained computer skills such that he served as an instructor in computer science in a small community college in central Florida.
Of course, my wife has more degrees than I do! She is an R.N., MSN, CRNP, MPH and a recent Ph.D. She has focused her career first on nursing, then on advanced practice nursing, then as a nursing educator, and most recently gained additional knowledge in environmental and occupational health.
Now that we are settled in Philadelphia, she has elected to take a faculty position at the Thomas Jefferson University School of Nursing, where she has a grant funded position working with minority and underprivileged nursing students, directing them towards advanced practice nursing careers.
What do you do during your time away from the hospital?
Iâ€™d say that my family occupies most of my â€œtime offâ€. On a good week, Iâ€™m able to have dinner with the family half the time. I enjoy working around the house, gardening, just being outdoors at our home.
I love to shoot basketballs in our backyard court. My wife and I play tennis, and I try my best to run or cycle twice a week. We go to an occasional movie, have a weekly dinner out, and have frequent social/business activities related to the Chair position.
Probably the time I enjoy most is the two week summer vacation we spend at the beach in North Carolina every year. For many years, we just went for one week, but for the last decade, weâ€™ve gone for two weeks, typically with my wifeâ€™s sister from Minnesota and other family. This is a very relaxing, rejuvenating, fun family experience, and I get to ride my bicycle daily for two weeks. Heaven!
Disclosure: the author of this interview is a member of the Department of Surgery at Thomas Jefferson University Hospital
Copyright 2007 InsideSurgery.com