Zealand Surgical Forum 2020

State-of-the-art oncological surgery for the patient with colon cancer

One of the biggest surgical events in Scandinavia

One of the biggest surgical events in Scandinavia

With a dedicated session for nurses

focusing on pre- and post-operative relations with patients

Three parallel operations

Streaming live from Zealand University Hospital

A great opportunity to network

while discovering the latest developments in the field

March 27 2020

Tivoli Hotel & Congress Center

Copenhagen, Denmark

State-of-the-art oncological surgery for the patient with colon cancer


ZSF2020 cancelled

We regret to inform you that due to the Danish Health Authority guidelines concerning the COVID-19 outbreak, as well as our speakers' travel restrictions for the same reason, we unfortunately have to cancel the Zealand Surgical Forum 2020. Full refund will be given to the already registered delegates. An email with more information regarding this will be sent to you soon.

We thank you for your interest in participating and we hope to see you at next year's symposium on March 19, 2021!

Registration date has ended, please contact the event organizer.

The incidents of colon cancer are rising worldwide, and the mortality is the second highest of any cancer in the western world. Within the recent years, huge developments have been made in the understanding of the disease and treatment of patients with colon cancer. Surgery is the primary curative treatment modality and recent research has confirmed that the variation in short- and long-term mortality is related to the perioperative and surgical treatment quality. 
This year at Zealand Surgical Forum we want to focus on colon cancer and discuss the new developments in the multidisciplinary treatment of this disease. We have the pleasure of including in our program leading experts to put a spotlight on the essential aspects of the diagnosis as well as the anesthesiological, surgical and oncological treatment options for the patient with colon cancer. Key invited speakers include Henrik Kehlet, Conor Delaney, Dion Morton, George Chang, Donal Buggy, Pieter Tanis and Anders Bertelsen. The scene will be set by patients who have undergone treatment for colon cancer and three operations, streamed live from Zealand University Hospital, will fuel our discussions during the day. In a parallel nurses’ session, speakers from Sweden, Belgium, the Netherlands and Denmark will explore the opportunities and challenges of pre- and postoperative relations with patients.
Join us on March 27 and participate in the lively discussions on the future aspects of the improvement of short- and long-term outcomes after colon cancer surgery. We look forward to welcoming you in Copenhagen!





Henrik Møller
Head of Department,
Chief Surgeon 
Department of Surgery
Zealand University Hospital
         Ismail Gögenur
Professor, Chief Surgeon 
Department of Surgery
Zealand University Hospital
and Copenhagen University


ZSF2020 Program Doctors Session
ZSF2020 Program Nurses Session
07:40 - 09:00
Registration and breakfast
07:40 - 08:10
Registration and breakfast
08:10 - 08:30
THE PATIENT: Two patients presenting their experiences going through treatment for colon cancer
08:30 - 09:10
THE SURGEON: The impact of surgery on morbidity and mortality in colorectal cancer surgery
09:00 - 09:10
09:10 - 09:55
Nursing: The Elephant in the Room?
In a recent article for the International Journal of Nursing Studies in which, after long deliberations, my colleague Professor David Richards and I, made the decision to discuss our thoughts about nursing by addressing what we regarded as the ‘elephant in the room’. We also took the decision to ‘call a spade a spade’ as we bluntly named the paper ‘Shitty Nursing’ – The new normal? At the end of the paper we encouraged readers of IJNS to reflect on our opinions and to engage in the debate at a Twitter account created specifically for this topic. My lecture will address the core of our published paper, share some of the interesting responses we got on Twitter (some of which caused me to close down my account), as well as describe comments from Danish and Norwegian colleagues. I will also try to reflect on how as nurses we ended up at these cross roads and how this is now strongly related to the newest nursing conviction - ‘fundamentals of care’.
09:10 - 09:40
THE ANESTHESIOLOGIST: Can anaesthetic technique during cancer surgery influence the risk of recurrence?
This lecture will summarise the rationale for the hypothesis that anaesthetic technique during cancer surgery of curative intent might potentially influence risk of recurrence. It will trace the development of this research question from the first retrospective analysis, through experimental research to a decade-long prospective, randomised, controlled clinical trial which was published recently. It will outline future directions in this field, including the emergence of a new clinical subspecialty of Onco-Anaesthesiology.
09:40 - 10:00
Coffee break
09:55 - 10:25
Making it short – is it possible to provide good nursing care in time-limited encounters?
Since the early 1990s the nature of treatment in health care has evolved rapidly. New treatment possibilities have arisen and the traditional treatments have been re-named in the light of current developments and improvements in medicine and technology. Reality is marked by a reduced amount of in-patient treatment and a rapid growth in treatments in facilities for short-term stay such as ambulatories, day care centers and out-patient clinics.
The practice of nursing must be adapted to the clinical context, and in today's health care, this increasingly means that nursing takes place in time-limited encounters. Knowledge of how to provide nursing in time-limited encounters is necessary for all nurses, because even hospitalized patients pathways will consist of a series of time-limited encounters with different health professionals.  
The focal point of the presentation will be the acceleration of time and the opportunities and challenges this presents in a hospital context? The focus will be on how it is possible to practice good nursing in a very short time? What good nursing really is? What does the nurse needs to know about the patient to be able to help him or her well and safely through the patient pathway, and how does the nurse achieve this knowledge about the patient?
The presentation points to very essential aspects of nursing care. And the go home message is to understand that a basic condition for the existence of a highly specialized nursing care is that it is based on a foundation of very fundamental aspects of nursing care.
10:00 - 12:30
Live Surgery
Case presentations
Live Surgery
  • OR1: Right-sided colon cancer surgery (CME with Intracorporeal Anastomosis and perfusion assessment)
  • OR2: Left-sided colon cancer surgery (CME with left flexure takedown)
  • OR3: Combined endoscopic laparoscopic technique for colon cancer or advanced adenoma
10:25 - 10:40
10:40 - 11:10
Coffee break
11:10 - 11:40
Patient participation on nursing wards and the bedside handover
The bedside handover of bedside shift report is a method in which the clinical handover between nurses is performed at the patient’s bedside, with participation of the patient. Although the method is not new, the interest in bedside handovers has drastically increased during the last decade. It is believed to improve patient participation, patient safety and nurses’ efficiency. However, rigorous research to prove these statements was, until recently, missing.
In a recent, and still ongoing mixed method study, 14 nursing wards in Flanders implemented the bedside shift report in order to explore its feasibility, appropriateness, meaningfulness and effectiveness of bedside handovers) as a specific method to increase patient participation on nursing wards. By use of systematic reviews (n=3), observations (n=1661), qualitative interviews before and after implementation (n=195), and quantitative questionnaires (n=954). By doing, the study tries to determine the added value of the bedside handover.
The study provides useful insight for the future use and implementation of bedside handovers as the new standard in nursing. The insights are translated into five practical statements for nursing practitioners and nursing managers to assist them in future implementation processes of the bedside handover. So far, the study concludes by stating that the bedside handover profiles itself as a suitable intervention, superior to the currently used methods for handover without patient participation, for those deliberately choosing for more patient participation and for those willing to make the organizational transition to more patient-centeredness.
11:40 - 12:10
From waiting to preparing: Prehabilitation on cancer patients’ terms
Knowledge about patients’ perspectives on prehabilitation is sparse. A better understanding could contribute to patient-centred prehabilitation programmes that enhance functional capacity and are considered relevant by patients – with a view to improving adherence.
To investigate cancer patients’ perspectives on a predefined, home-based, multimodal prehabilitation programme with particular attention to feasibility and acceptability.
 Patients and Methods
Fifteen patients with peritoneal carcinomatosis of colorectal or ovarian origin undergoing cytoreductive surgery, with or without hyperthermic intraperitoneal chemotherapy, participated in semi-structured interviews. Malterud’s principles of systematic text condensation were used to analyse the data.
Patients had a positive attitude towards home-based prehabilitation. Yet, they would not follow the programme unconditionally, and several barriers to adherence were identified:
Everyday life: Patients focused on maintaining their everyday lives.
Preferences: Patients prioritised enjoyable activities especially in relation to exercise and nutrition.
Restrictions: Smoking and alcohol cessation led to concerns, as the preoperative period was perceived as stressful enough as it was.
Lack of belief: Some patients did not believe that they could influence recovery themselves.
The findings underscore the complexity of developing a home-based programme that not only enhance functional capacity, but are also experienced relevant to the patients. Furthermore, it demonstrates how patient involvement in research has the potential to change preconceptions and change research plans.
12:10 - 12:40
Enhanced rehabilitation after abdominal surgery
Are we done nursing when the patient has been discharged? Or could we do more to secure a successful self-rehabilitation? 

We might think that we have done the perfect job when discharging our patients after a successful abdominal surgery. But how does the patient experience the discharge and how empowered do we leave the patient to self-rehabilitation? 

Science indicate that there is an increased risk of postoperative complications and problems in maintaining the functional status of this patient group, if we fail to empower the patient properly.

But what concerns and challenges is actually faced by the patient? And how could we as professionals reduce the risk of complications and increase the patient’s ability to complete a successful self-rehabilitation?

This session will explore this topic and shed light on three key areas to focus on, when creating the optimal circumstances for successful self-rehabilitation.
12:30 - 13:15
12:40 - 13:00
13:00 - 14:00
13:15 - 13:40
ERAS: State-of-the-art perioperative care
Enhanced recovery (ERAS) was introduced in the mid-90's and since then repeatedly documented to improve postoperative outcome regarding length of stay and medical complications without increasing readmissions. Due to the complexity of postoperative recovery, several challenges remain to be solved including the surgical stress responses (inflammatory) where further research is required to reduce the “high-inflammatory” responders. Also, more procedure-specific research is required in pain management and with a focus on high-pain responders (pain catastrophizers, opioid users, etc.). Although most focus has been laid on length of stay, the important future challenges are to find the right balance between major outpatient vs. inpatient surgery regarding safety. Furthermore, to objectively assess post-discharge functional outcomes where new technology is available. Finally, a challenge exists about how to make progress, where the two extremes being big pragmatic RCT’s vs. minor detailed hypothesis-generating cohort studies.
In summary, ERAS has come to stay, but need further improvement, implementation, better procedure-specific evidence of ERAS components and improved study design of ERAS, all based on the concept of “first better – then faster”.

Joshi GP, Alexander JC, Kehlet H. Large pragmatic randomised controlled trials in peri-operative decision making: are they really the gold standard? Anaesthesia 2018;73(7):799-803. 
Memtsoudis SG, Poeran J, Kehlet H. Enhanced Recovery After Surgery in the United States: From Evidence-Based Practice to Uncertain Science? JAMA 2019;321(11):1049-1050. 
Kehlet H. Enhanced postoperative recovery: good from afar, but far from good? Anaesthesia 2020;75 Suppl 1:e54-e61.
13:40 - 14:05
Complete Mesocolic Excision
Complete mesocolic excision is now considered the gold standard of surgery for right-sided UICC stage I−III colon cancer, but the evidence for left-sided cancers is more contradictive. Some issues regarding CME are still debated. This presentation will discuss these issues from a Danish perspective with a focus on right-sided complete mesocolic excision. How do we select patients for right-sided complete mesocolic excision? Is the risk of perioperative complications acceptable? Which improvements in long-term outcomes as risk of recurrence and overall survival can we expect? Is the risk of bowel dysfunction increased after complete mesocolic excision?
14:00 - 14:45
Different nursing handover styles for hospitalized patients
The process of handing over care is one with a high potential for error. Standardization of the handover process is deemed necessary to ensure continuity and safety of care. However, the handover process is also influenced by cultural and environmental issues that are not measurable and easy to standardize. This local context is of equal importance to improve the handover process. 
To capture the local context we used an iterative three round evidence based consensus approach with a group of nurses representing the clinical departments of our hospital to develop a blueprint for nursing handover. This process resulted in consensus on a set of 18 recommendations on how, what and where to handover as well as a bedside-safety check. In a pilot implementation of the blueprint we observed a continued trend of improvement in handover quality. The nurses perceived the use of the handover blueprint as an improvement and refinement of the existing handover process. Especially the introduction of the bedside-safety-check at shift handover was highly appreciated.  
For complex processes such as the handover process, a stepwise iterative approach and involvement of local users in the development, implementation and evaluation is essential to ensure a successful implementation. 
14:05 - 14:30
Surgery in Stage IV: Primary tumor resection
14:30 - 14:55
Chemotherapy: Adjuvant treatment option for the patient with colon cancer. Is neoadjuvant treatment for the colon cancer ‘prime-time’?
14:45 - 15:15
Moments of beauty in nursing
This presentation concentrates on the question: What happens when certain moments in-between nurse and patient lights up and invite us into shared experiences of human end ethical meaningfulness?
With a theoretical departure in philosophical aesthetics put forth by Dorthe Jørgensen, the presentation points to such moments as moments of server beauty. This presentation inquiry into moments of beauty in nursing by questioning, how it is possible to describe the being of nurses in such moments, from a phenomenological and ontological approach.
The empirical departure is a phenomenological action research project named:  ‘Moments of beauty in Nursing – a source of innovation’. The research was anchored in 3 hospital wards in Denmark and 15 nurses participated as co-inquirers.
Through phenomenological descriptions and reflections a concept of ‘shared sensitive presence’ rise. ‘Shared sensitive presence’ refers to situations, where nurse and patient both are under the impression from communal life phenomena, while the phenomenon unfold. For example, nurse and patient in togetherness sense and share mortality as a communal human ground and existential reality.
In this presentation, Sine Maria Herholdt-Lomholdt will describe, explore and discuss ‘shared sensitive presence’ as a phenomenon that seems to exist in nurse’s practice. The phenomenon will be clarified using Baumgartens concept: ‘sensitive recognition’ and through the lenses of Heidegger. The phenomenon of ‘Shared sensitive presence’ will also be contrasted to other ways of describing similar situations, as eg. Carl Rogers concept of ‘empathy’ and Jungs archetype ‘The wounded healer’.
14:55 - 15:05
Panel Discussion
15:05 - 15:30
Coffee break
15:15 - 15:35
15:30 - 15:50
The prospective randomized clinical trial: The Dutch Perspective
Interesting fields for research in the treatment of colon cancer for the future are organ preserving treatment of early cancers, precision (neo)adjuvant treatment in combination with segmental resection, and multimodality treatment of locally advanced disease.
The RCT is probably not the appropriate study design to test technical innovations (i.e. Dutch LIMERIC II study) or active surveillance protocols that might safely replace segmental colectomy in early cancers. For the purpose of further reducing the indication and amount of (neo)adjuvant systemic therapy in stage II-III colon cancer, RCTs might be designed, but testing of (panels of) biomarkers can be more efficiently performed in large cohorts. Prevention, early detection and treatment of peritoneal metastases is subject of RCTs in the Netherlands (COLOPEC I and II, CAIRO 6), but new effective intraperitoneal treatment modalities should first be explored in organoid and animal models, before re-introducing this into clinical studies.
15:35 - 16:00
Coffee break
15:50 - 16:10
The prospective randomized clinical trial: The UK Perspective
16:00 - 16:55
Patient's perspective
16:10 - 16:30
Is Big Data the solution? Technological advances in perioperative care
16:30 - 16:50
Is Big Data the solution? Personalized medicine in colon cancer
16:50 - 17:00
Closing remarks
16:55 - 17:00
Closing remarks
17:00 - 18:00
Drinks and networking
17:00 - 18:00
Drinks and networking

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Tivoli Hotel & Congress Center

Arni Magnussons Gade 2, 1577 Copenhagen


ZSF2020 Platinum sponsors

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