Marc Bernon

Hepatopancreaticobiliary surgeon at Groote Schuur & UCT Private Academic Hospitals

[Nicholas Hornstein @GIMedOnc]

Is it sexy? No.
Is it incredibly important for how we treat patients? Absolutely 🧠🧬

For over 20 years, 6 months of oxaliplatin plus a fluoropyrimidine has been the default for stage III colon cancer, and often high-risk stage II and rectal cancer. The cost has always been cumulative neuropathy that can follow patients for life ⚡️🖐️

The SCOT trial, the largest study in the IDEA collaboration, gives us long-term clarity with nearly 6,100 patients and more than 6 years of follow-up:

📊 5-yr DFS identical with 3 vs 6 months: 72.9% vs 72.9%
📈 5-yr OS identical: 82.4% vs 82.4%
✅ Noninferiority for OS formally met for 3 months

Where this really matters clinically:
🟢 CAPOX clearly supports 3 months
🟢 Low-risk stage III shows no OS penalty
🟡 Even high-risk disease sees only tiny absolute OS differences

⚠️ Meanwhile, neuropathy nearly doubles when oxaliplatin is extended to 6 months. Many patients pay a lifelong price for minimal benefit.

SCOT also uniquely included rectal cancer patients treated with upfront surgery, and here too, 3 months held up. This fits perfectly with modern TNT strategies 🧩

Takeaway:
This isn’t flashy, but it’s foundational. For most patients with localized colon or rectal cancer, 3 months of adjuvant CAPOX is enough. Six months should be the exception, not the rule, and always a shared decision 🤝

Sometimes the most important advance is knowing when to stop.

@OncoAlert @TheGutOncLab
#GI26

https://t.co/geX09H4ltq

[BJS Open @BjsOpen]

Reinforced tension-line suture after laparotomy: long-term results of Rein4CeTo1 randomized clinical trial
➡️https://t.co/AqYmnd5yex

The aim of this randomized clinical trial was to investigate whether a reinforced tension-line (RTL) suture reduces 3-year computed tomography-detected incisional hernia incidence. The RTL technique significantly reduced the incidence of incisional hernia compared with the standard facial closure technique in patients undergoing open colorectal cancer surgery. The incisional hernia incidence was 6 of 43 (14%) in the RTL and 21 of 58 (36%) in the standard facial closure group.

👏👏👏Charlotta L Wenzelberg , Peder Rogmark , Olle Ekberg , Ulf Petersson , Carl-Fredrik Rönnow
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery @eurohernias #hernia #hernia @herniaistanbul @BritishHernia @HerniaIndia @awrsurgeons

[Mark Sonderup @mark_sonderup]

@mailandguardian Please @IrlEmbPretoria @austingormley1 then explain why a group of doctors from RSA could not attend a meeting in Dublin because visas not processed in time (submitted 6 weeks in advance)….? Impose a Visa your choice - incompetence on processing time - your responsibility

[Jasmohan Bajaj @JasmohanBajaj]

It's finally here! Consensus #ACLF & #cirrhosis organ failure definitions. @AGA_Gastro ⤵️
https://t.co/Z3YN3Ta9iR
Why? We need to speak the same language re #ACLF for #transplant/new Rx dev
How? Multi-country consensus panels
Result? Harmonized definitions &  research agenda

[Marc Bernon @MarcBernon]

https://t.co/BveoOe1e4p

[Marc Bernon @MarcBernon]

The E-AHPBA meeting is under way in Dublin without many of it's members from Southern Africa. Research from South Africa is not being presented and surgeons are missing out on a learning opportunity. The Irish Visa application process is a shambles. @IrlEmbPretoria @IrlAmbRSA

[Marc Bernon @MarcBernon]

The HPB association of Southern Africa has written to the E-AHPBA (see the link below). There has been good South African attendance at the previous meetings in Germany, The Netherlands and France. The Irish meeting is going to be remembered for the wrong reasons @IrlAmbRSA

[Giovanni Marchegiani @Gio_Marchegiani]

Left side pancreatectomy 🙊 do we speak the same language?!

🌍 International Delphi consensus

4️⃣ resection categories based on anatomy + additional procedures / technique 🔪🤖

👉 Distal is not just “distal”…

https://t.co/TJ2skZEuvM

[Giovanni Marchegiani @Gio_Marchegiani]

💎 Pearls from @IHPBA 2024 🇸🇸

Total pancreatectomy revisited - what are your indications?! 🎙️@MarcBesselink

👹 Brittle diabetes impairs QOL
🙈 MD IPMN not an indication per se

🐳 High risk anastomosis a justifiable indication?

Or are we “shooting our opponent in boxing?” 🥊

[Giovanni Marchegiani @Gio_Marchegiani]

Liver resection 🤜🤛 non surgical treatments for early multinodular HCC

🧀 720 patients surgery vs. RFA / TACE

😳 Surgery higher survival rates at 1, 3 and 5 years

💡Liver resection should be considered the first therapeutic option

https://t.co/zyIT62OLVc

[Shiva Jayaraman @cutitoutPODCAS1]

Sometimes seems #noBDI and #SafeChole seems like 2 steps forward + 2 steps back

Still too many bile duct injuries. We have work to do. Errors & decisions in video from old Tweet below still too common, as this vid shows (posted with permission) @SAGES_Updates @IHPBA @CAGS_ACCG

[Giammauro Berardi @Giammatwit]

🤔38yo HCC on cirrhosis, severe portal hypertension 🌡️

😌C’mon it’s “just” a wedge resection

🎥 Intraoperative view ⬇️

😱😨🥶

@rubenciria @EAHPBA @IHPBA @hpb_so @HpbChl @HPB_influencer @marcodoc79 @ThielsCA @magpao @AnnalsofSurgery @shakermd12 @Shrikhande_SV

[Giovanni Marchegiani @Gio_Marchegiani]

Diagnostic mistake 🙈 in pancreatic cyst ‼️

Despite guidelines and wide use of EUS (50%)

30% misdiagnosis pre 🤜🤛 post op

😱 Relevant mistakes include
60% of all cystic NET 🦓
13% presumed serous cysts > malignant 👹
25% HRS IPMN > bening 👼

👉 https://t.co/0Hvbz0Uo5M

[Giovanni Marchegiani @Gio_Marchegiani]

Liver transplant for colorectal cancer mets 😱 long term results from 🇳🇴

🧍‍♂️61 pts with non resectable CRLM in 14 years

👍 Predictor of outcomes were tumor size, CEA, number of lesions

🔟 year survival of 90% for Oslo score 0

🏔️ A new milestone ?!

https://t.co/gwu2nVCpoC

[Philip C. Müller @PhilipMueller_1]

💥Contemporary artery first approaches in PD summarized for @young_bjs

⁉️What is your favorite approach to the mesenteric vessels?

🙏🏼grateful for the opportunity @BJSurgery and @young_bjs

🔑open access
https://t.co/rY4cvAUaCF

[Marc Bernon @MarcBernon]

@jacob_maroga Mbeki is correct a little bit of knowledge is a dangerous thing. He clearly new very little about HIV. He is responsible for the deaths of over 200 000 Africans from HIV. A disgrace and a pseudo- intellectual

[Geordin Hill-Lewis @geordinhl]

I've written to Mayor Klitschko of Kyiv to express Cape Town's solidarity with Kyiv's residents and all Ukranians.

Our City Hall will be illuminated tonight in azure and yellow — the colours of Kyiv's flag.

Cape Town is joining the world in taking a stand against tyranny.

[Marc Bernon @MarcBernon]

@rosshofmeyr Perhaps if it’s left in for longer than 24 hours

[BJS Open @BjsOpen]

A follow-on #cohort study after the COLOFOL #RCT looks at 5 year recurrence rate patterns after treatment of stage II/III #colorectalcancer .

1 in 5 chance of recurrence in this study, with varying profiles:

#openaccess #some4surgery

https://t.co/oDYhZGeX0n