Imran Raza

Love and support the principles of our NHS. Consultant in Sarcoma, Colorectal and Pelvic surgery. Father. Cyclist. Nerd. Personal account and personal views

[Ron Barbosa MD FACS @rbarbosa91]

As you get older you’ll learn that 30 minutes a day spent exercising is going to impact your surgical career more than spending those 30 minutes on the computer.

Buy whatever equipment, membership, or clothes you have to buy for it. Tell your spouse or partner I said so. 🏃‍♂️🚴‍♀️

[Dr Rupam Manna MD @DrRupamOncology]

🚨 GIST TREATMENT MASTERCLASS – ULTIMATE EDITION 🔥
The most complete high-yield infographic you’ll ever need:
✅ Risk Stratification (Miettinen/AFIP table) – size, mitotic rate, site & rupture
✅ Choi Criteria (VERY HIGH YIELD) – why density drop beats RECIST in GIST
✅ Mutation-Based Algorithm (SUPER HIGH YIELD) – KIT exon 11/9, PDGFRA D842V → Avapritinib
✅ Complete Management Flow – Localized, Borderline, Metastatic & Special Cases
✅ Exam-critical pearls + Mutation & Treatment at a Glance table
Precision oncology prototype • NCCN-aligned • One-shot revision gold
Save this for rotations, boards & wards 📌
Tag a fellow/resident/fellow who lives on #MedTwitter 👇
RT if this just became your new GIST bible!
#GIST #Oncology #MedEd #HemeOnc #PrecisionOncology #TargetedTherapy #Cancer #MedTwitter

[Dr Asif Qasim MA PhD FRCP @DrAsifQasim]

Professor Harold Ellis died yesterday aged 100.

Fond memories of undergraduate anatomy at @Cambridge_Uni an inspiration and mentor to generations of doctors

May he rest in peace

[Hassan R. Hashmi, MD, FACS, DABS @HassanRHashmiMD]

A strong signal from high-level evidence in colorectal surgery.

A recent meta-analysis of randomized trials (n=4754) published in @LancetGastroHep demonstrates that indocyanine green fluorescence angiography (ICGFA) significantly reduces anastomotic leak rates (RR 0.66, NNT 24).

The benefit is particularly compelling in:

• Left-sided resections
• Rectal resections
• Low anterior resections (NNT as low as 13)

Notably, the protective effect increases with higher BMI, suggesting a meaningful role for selective use in higher-risk patients. No significant benefit was observed in right-sided resections.

Trial sequential analysis indicates that sufficient evidence has likely been reached. The question is no longer ��does it work?” but:

How do we implement it effectively?
Which patients would benefit the most?

As we continue refining anastomotic safety, this reinforces a broader principle of objective perfusion assessment.

Are you using ICGFA routinely, or selectively?

#ColorectalSurgery #ICGFA #EvidenceBasedMedicine #ICG #ASCRS #ACS

@ASCRS_1 @AmCollSurgeons @SWexner @SoniaRamMD @KirstenBWilkins @GaertnerWB @SeanLangenfeld

[The Lancet Gastroenterology & Hepatology @LancetGastroHep]

🆕Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: a systematic review with meta-analysis, meta-regression, and trial sequential analyses

https://t.co/5QaeBVVe3E

#GITwitter #SurgTwitter

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 111
📌Gauze-Made Plane Dissection
📝In laparoscopic sigmoid colectomy, a folded gauze is used to elevate the mesentery with a broad surface, allowing wide and safe exposure of Toldt’s fusion fascia and facilitating rapid dissection.
🖊Desmoplastic reaction classification
#JSESイラストコンテスト　#JSES_illustration_contest

[Nicholas Hornstein @GIMedOnc]

The intuition makes sense. Reduce tumor burden, let systemic therapy finish the job. But intuition has a poor track record in oncology.

ORCHESTRA just published in JAMA. Phase 3 RCT, 382 patients, multiorgan mCRC. The bar for entry was high. You had to be able to take out more than 80% of disease burden across all sites before randomization. These are the best-case patients. Response or stable disease after 3-4 cycles of CAPOX or FOLFOX, then chemotherapy alone versus chemo plus debulking.

Median OS: 27.5 months versus 30.0 months. HR 0.88, 95% CI 0.70-1.10. p = 0.26. PFS essentially identical, 10.4 versus 10.5 months. Serious adverse events significantly higher in the debulking arm, 53% versus 39%.

That said, this isn’t the whole story. Symptomatic Krukenberg tumors, oligometastatic disease with curative intent, isolated liver-only disease. Those conversations should still be had.

The cytoreductive surgery literature gave us hints this was coming, but the use cases that make biological sense still stand.

What changes now? At minimum, “we can get more than 80% of it” is not a sufficient reason on its own. Except in NETs, NETs are weird.
https://t.co/yBHjrfGkO6

@gutonclab @oncoalert

[Imran Raza @Imranraza]

Just stunning! I'll get my trainees to draw this next time instead of writing an op note

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 107
📌See the Concept: Illustrated Laparoscopic Sigmoid Colectomy
📝This illustration shows our standard laparoscopic sigmoid colectomy. It marks incision and mobilization directions, outlines the operative flow, and helps surgeons, trainees, and nurses understand each step.
🖊Nakata
#JSESイラストコンテスト　#JSES_illustration_contest

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 107
📌See the Concept: Illustrated Laparoscopic Sigmoid Colectomy
📝This illustration shows our standard laparoscopic sigmoid colectomy. It marks incision and mobilization directions, outlines the operative flow, and helps surgeons, trainees, and nurses understand each step.
🖊Nakata
#JSESイラストコンテスト　#JSES_illustration_contest

[Dirk Strauss @Dirk_Strauss]

Soft tissue sarcomas: recent therapeutic advances, multidisciplinary management, and the centralization of care in high-volume centres to optimize outcomes. Excellent review!!

[BJS @BJSurgery]

Identifying novel indicators of non-technical skills derived from operative video annotation
➡️https://t.co/osqBZtpssC

🤖 Can surgical gestures reflect cognitive skills? This study tested whether video-derived gestures can indicate surgeons’ cognitive non-technical skills (NTS).
🎥 Methods: 40 laparoscopic appendicectomy videos analysed (10,385 events; 87,374 data points). Twelve experts rated decision-making and situation awareness using NOTSS.
📊 Results: Mean cognitive NOTSS 5.6/8, with strong correlation between domains (r = 0.8; P < 0.001). Video-derived metrics explained 39.6% of variance in expert ratings.
🚀 Take-home: Cognitive NTS may be inferred from surgical video alone, enabling scalable automated assessment tools.

Work by Lachlan Dick, MBChB , Connor Boyle, MBChB , Victoria Ruth Tallentire, MD , Joe Norton, MBBS , Emma Howie, MBChB , Douglas S Smink, MD, MPH , Richard J E Skipworth, MD , Steven Yule, PhD on behalf of , the Surgical Video Grading and Assessment (SVGA) Group

#SurgicalEducation #NOTSS #SurgicalAI #SurgicalTraining #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology
#Some4COLoprocto

[Husam Ebied @drhossam35]

My new website is now live — a dedicated platform for patients seeking expert hernia and abdominal wall care in London.

https://t.co/QhGEIE9awZ

[Husam Ebied @drhossam35]

Expert-led free AWR cadaveric masterclass in St Thomas Hospital London in collaboration with medtronic on the 10th April

Delighted to invite consultants and senior trainees with an interest in abdominal wall reconstruction to attend @BritishHernia @asgbi @eurohernias

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 85
📌Ta/Tp PE : Anatomy Through the Perineal Lens
📝At our department, transanal and transperineal pelvic exenterations (Ta PE and Tp PE) are performed by two teams: abdominal and perineal. This illustration shows the right pelvic side from the perineal approach.
🖊Nonaka Yukiko
#JSESイラストコンテスト　#JSES_illustration_contest

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 81
📌D3 Lymphadenectomy with Left Colic Artery Preservation during Laparoscopic Low Anterior Resection
📝By arranging simplified sequential diagrams, I illustrated the key points of D3 lymphadenectomy with preservation left colic artery.
🖊Anonymous
#JSESイラストコンテスト　#JSES_illustration_contest

[Keith Siau @drkeithsiau]

Surgical repair of a ventricular septal defect (hole in the heart) in a child 🤯🙇🏻‍♂️

[Irshad Shaikh @ishaikh4]

@IntuitiveSurg congratulations @NNUH @uniofeastanglia for acquiring two more systems and 4 in total for our multispecilty programme.

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 76
📌Robotic Distal Pancreatectomy: A Visual Guide from Exposure Techniques to Postoperative Complication Prevention
📝This illustration was created with passion by a budding female gastrointestinal surgeon?also the creator of the popular LINE stickers “Shokakigekai-kun.”
🖊Kaoperin
#JSESイラストコンテスト　#JSES_illustration_contest

[Dr Abhilasha Manwatkar (AIIMS Nagpur) @Abhilasha21822]

At CMC Vellore, we had one of the most renowned immunology labs in the country.😇

Yet ANA blot was NOT available...🥲

Not because it couldn’t be done
but because we were taught something more powerful:😎

“Clinical evaluation first.
Order only what will change your decision.”

At the time, it felt limiting.
Today, I realize it was deliberate training.👩🏾‍🔬🕵🏽‍♀️

Because great clinicians are not made by unlimited panels …
they are made by sharp history, careful examination, and thoughtful questions.👩🏾‍🔧

The lab is an extension of your brain.
It should never become a substitute for it.👩🏾‍🔬

That philosophy from CMC shaped how I practice today.

Bedside before bloodwork.
Thinking before ticking boxes.

#ClinicalMedicine #MedicalEducation #CMC Vellore #Rheumatology #MedTwitter

[DCRjournal @DCRjournal]

Retrospective cohort study of long-term results of LIFT for perianal fistula. Read more in this month's #DCRJournal: https://t.co/mKfr5IiSQO