The David G. Jagelman memorial International Colorectal Disease Symposium is an initiative of the Department of Colorectal Surgery at the Cleveland Clinic Florida that has been conducted consecutively for the past three decades. The first meeting took place in 1990 and ever since the Cleveland Clinic Florida has been hosting it annually in Fort Lauderdale, Florida. This annual symposium was originally defined by its chairperson for the past two and a half decades, Prof Steven D. Wexner, as ’a course’, and included all invited lectures from leading colorectal surgeons worldwide. In later years, the Department of Colorectal Surgery at Cleveland Clinic Ohio joined this initiative, and in the past few years the symposium has included several free paper sessions. After celebrating the symposium’s 30th anniversary in February 2019 in Florida with hundreds of attendees from all around the world, it was decided to continue this annual get-together at another international location biennially and back in Florida intermittently.
During the past 30 years, the Department of Colorectal Surgery at the Cleveland Clinic Florida headed by Dr Wexner has trained many surgeons from all around the world both as research fellows and in clinical positions. A unique group of those were Israeli surgeons who came to Florida following completion of their training in general surgery seeking additional training in colorectal surgery, and whom completed a combined research and clinical 2-year fellowship programme. Given this group of Israeli alumni, it was only natural that the first international colorectal disease symposium outside of the USA was to take place in Israel. Dr Wexner offered this opportunity during the annual Israeli Surgical Association meeting in May 2019, and both the Israeli Surgical Association and the Israeli Society of Colon and Rectal Surgery were understandably happy to accept the offer and host the meeting.
The meeting took place at the David Citadel Hotel overlooking the old city of Jerusalem from 26th–28th February, 2020. Jerusalem was first built 3,000 years ago and was the focus of many historical and religious events. Nowadays it is the Israeli capital and the largest city of the country with a population of approximately 930,000. This city appears in old maps at the centre of the world, and many describe it as a city of overwhelming emotions that promises religious and spiritual experiences. Four-hundred and twenty-seven participants attended the meeting, including 130 Israeli surgeons, 202 surgeons from 36 countries around the globe, and 95 industry representatives. The faculty included 77, of whom 22 were Israeli and 55 international. There was no disputing the number of attendees and variety of countries they arrived from being second-to-none compared to previous surgical conferences that have taken place in Israel in past decades.
The scientific programme comprised 10 plenary sessions and three multidisciplinary panel discussions. Eight of the plenary sessions included invited lectures and two were free paper sessions during which 21 abstracts originating from 10 different countries were presented. A pre-conference intra-operative fluorescence imaging day preceded the symposium. This day included three plenary sessions from leading surgeons and industry representatives regarding this cutting-edge technology. The organising committee planned the main symposium programme with a major focus for each day: rectal cancer was the focus of the first day, inflammatory bowel diseases was that of the second, and pelvic floor was that of the third. This focus along with the lively multidisciplinary panel discussions proved to be a great success, and raised interest and audience involvement.
Turning attention to the social aspect, the meeting location at Jerusalem was magical. The close proximity of the venue in walking distance to the Old City along with the perfect weather induced a unique atmosphere. The meeting was the largest of its kind in Israel yet intimate in its international scale, which along with the social events brought people from all around the world together. The authors anticipate some developments in the field of colorectal surgery and hope that these will be incorporated into the 32nd symposium in Fort Lauderdale, Florida, USA. Intraoperative radiation for recurrent rectal cancer and cancers where it is impossible to achieve an R0 resection is increasingly utilised throughout the world. The growing experience with intraoperative radiation would hopefully benefit patients with advanced rectal cancer. Ergonomics of surgical procedures and their contribution to surgeon safety are also recognised as being extremely important. That may be one of the most important advantages of robotic surgery over laparoscopic surgery. Surveillance of the long-term physical injuries to surgeons from laparoscopic surgery (hand injury, herniated cervical disks) is of vast importance and may affect our future surgical practice.
The coronavirus outbreak has changed the practice of colorectal surgery throughout the world. Lessons have been learned in all facets of the profession: patient and surgeon safety, evacuation of CO2 following laparoscopy, Zoom™ meetings, changes in medical student education, and follow-up of patients via remote visits. All that may change our perspective of daily practice, even long after the outbreak has ended. Hopefully, in 2021, the 32nd International Colorectal Diseases Symposium will be a great meeting, answering some of these important new debates.
This meeting took place at a unique point in history, when the coronavirus outbreak had reached its peak in the Far East and was starting to evolve in Europe as well. On the last day of the meeting, the Israeli ministry of health issued a recommendation not to travel to international conferences any more nor to hold international conferences in Israel. Luckily, we were able to hold the meeting ‘in the last minute’ prior to these recommendations coming into force. Soon afterwards, both the European Society of Coloproctology (ESCP) and the American Society of Colon and Rectal Surgeons (ASCRS) cancelled their annual meetings scheduled for later this year. We hope that by 2021 meetings such as ours will be possible once again, and we look forward to the 32nd International Colorectal Disease Symposium in Fort Lauderdale, Florida.
We feel fortunate and grateful having been able to take part in this wonderful educational meeting, most probably the only international colorectal surgery meeting of 2020, in our hometown of Jerusalem, Israel.