50 years of Schwartz’s Principles of Surgery celebrated

Surgeons celebrated the past, present, and future of surgery during a Special Session Tuesday, 50th Anniversary Celebration of Schwartz’s Principles of Surgery: First Edition: A Retrospective and Futuristic View. Clinical Congress 2017 marks 50 years since Dr. Schwartz completed the manuscript for the first edition, which has influenced generations of surgical clinicians and researchers, making this anniversary a cause for celebration.

When the first edition of Schwartz’s Principles of Surgery was published in 1969, the surgical profession was drastically different than it is today, according to David C. Linehan, MD, FACS, a cancer surgeon and chair of the department of surgery, University of Rochester Medical Center, NY, who co-moderated the session with American College of Surgeons Past-President Seymour I. Schwartz, MD, FACS, the author of the seminal text.

In recognition of the anniversary, Dr. Schwartz asked experts at the University of Rochester, where he is celebrating his 60th year on the faculty, to look at each of the book’s 52 chapters and determine what areas had significantly changed and what information was no longer accurate. “The chapter on cancer was quite interesting,” Dr. Linehan said. “There was a whole paragraph that said you probably wouldn’t really want to disclose a cancer diagnosis to the patient because the news might be too upsetting for the patient and make the outcome worse.”

Dr. Schwartz noted “factual does not imply permanence” and that much has changed since he wrote those words, which are among some of the principles in the first edition that he would now refute. “Change pertains to both the diagnosis and the treatment of disorders,” Dr. Schwartz observed.

At the time that Dr. Schwartz wrote the first edition, “the development of the [American Joint Committee on Cancer’s] definition of liver diseases was two decades” in the making. Furthermore, “the only organ transplanted with anticipated success was the kidney.”

As another example, in the first edition, Dr. Schwartz advised removal of the appendix as the only effective treatment for acute appendicitis, whereas now some cases can be treated with antibiotics. Similarly, antibiotics are now used to treat peptic ulcer.

In addition, the development of new imaging technology, including computed tomography and magnetic resonance imaging, has made it possible to diagnose many surgical diseases without opening up the patient. Some of the most significant advances in treatment have occurred in transplantation and cancer treatment.

Other speakers in the session included John Fung, MD, FACS, chief of transplantation, University of Chicago Medicine, IL, a mentee of Dr. Schwartz; and Ryan Fields, MD, FACS, associate professor of surgery, Washington University School of Medicine, St. Louis, MO, a mentee of Dr. Linehan. Dr. Fung described the history of transplantation, noting that the first successful liver transplant occurred in 1967 at the University of Colorado, Denver. He observed that progress in the development of immunosuppression in the 1970s made transplantation a more viable treatment option. “There are now more than 130 transplant facilities,” Dr. Fung said.

Dr. Fung speculated on the future of liver transplantation, pointing to advances in approaches to genetic modification, such as CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) technology, as pathways to the future.

Dr. Fields described Dr. Schwartz’s text as his “looking glass,” and spoke of advances that he sees occurring in cancer surgery, including “personalized and precision approaches, improved diagnostics with both prognostic and predictive characteristics, vastly improved imaging, and a changing, but not decreasing role for surgery.”

Clearly, the first edition of Schwartz’s Principles of Surgeryset the groundwork for many of the advances that have occurred in surgery over the last 50 years. A new edition is scheduled for release in the next two years, setting the stage for further advances in the future.