ALPS 2017

ALPS 2017: reflection on a decade.

In 2017 we had the11th ALPS HPB meeting and the highest attendance to date. Traditionally, a trainee writes the report but on this occasion I thought it might be helpful to reflect on the origin, development and future of the meeting. Like many of the best ideas, ALPS came out of a chance conversation. I was talking with Mo Abu Hilal along the lines that since the colorectal surgeons had an alpine meeting, shouldn’t HPB surgery? Merv Rees, at that time AUGIS President-Elect, was in agreement and so the idea developed.

The location – Madonna di Campiglio in the Italian Dolomites – is perhaps not especially well known in the UK. It was, however, well know known to Mo who trained initially in Verona with Claudio Bassi, and the contact with the hotel which has been the venue ever since, originated from him. The resort is also just over two hours from a number of airports so relatively convenient. It is also possible to ski virtually all the local ski areas without a flake of natural snow, which at the start of this year, was very much needed!

The first meeting was relatively small. By recollection there were around 30 attendees and the inaugural guest speaker was Daniel Cherqui from Paris. The meeting established the format that has run subsequently – a very high quality of academic presentations morning and evening, a single hotel venue in which all delegates stay, a varied social programme and, crucially, a lot of time for interaction between faculty and attendees of all grades, both daytime and evening.

For the first couple of years, the meeting was dominated by UK attendees with just a few from other, mainly English speaking countries. This changed radically in 2011 when the Dutch group led by Marc Bemelmans from Maastricht joined and since then the meeting has been truly international. The UK attendance remains substantial but now in the minority. Apart from the Dutch, the Nordic countries, Australasia, the USA and Italy are all well represented. Reflecting this, the organising committee also includes membership from Norway (Åsmund Fretland) and the USA (David Tuveson).

Throughout the past 10 years we have had some of the biggest names in the world of HPB surgery at the meeting and each year the meeting attracts more attendees. The 2017 meeting was the biggest so far and highlights included talks by Nicolas Demartines (Lausanne) and Kristoffer Lassen (Oslo) on ERAS and diverse talks from Peter Kingham (New York) which varied from molecular signatures in colorectal liver metastases to global surgery. Tom Wilson (Adelaide) gave an insightful talk on volume and outcome and Rob Padbury, (also Adelaide), gave an excellent talk on measurement and quality in surgery.

This year the abstract submissions were not just up in number but also in quality. Rather than decline excellent work we introduced e-posters presented during the pre-meeting coffee session. This worked well and will be repeated. The oral presentations were very impressive with the outright winner being Colin Wilson (Edinburgh) for his work on a helminth derived immunosuppressive factor. The poster prize was won by Joni van Hilst (Amsterdam) for a worldwide survey on minimally invasive pancreatic surgery.

Traditionally we award a prize for the worst ski injury but for a second successive year there was no meritorious application. Tom Wilson applied on the basis that he took out a skier at a lift resulting in some noticeable blood loss, albeit not from him. He later fell in the bathroom and produced a large bruise. He was disappointed to be told that neither claim could be accepted as firstly the blood loss was not his and secondly the later fall was not actually sustained whilst skiing. Perhaps in 2018 we will be back on track!

Despite having very little industry support the meeting has remained inexpensive by having essentially no visible administrative costs (run from a University Department on goodwill) and with no discounted attendance for organisers and speakers (with the exception of non-surgeons). But the success of the model has its own problems and the capacity to deliver is now beyond that of a single department. So for the 2018 meeting and onwards we will seek a more sustainable solution with professional administration. In terms of cost to attendees there may be a small net increase but this is unlikely to be noticeable. There has always been a registration fee and with increased attendance there is more resource available to cover costs. It is likely that most can be covered by unbundling some of the components that are presently included, for instance the Thursday evening mountaintop party, which in any case does not appeal to all (I might say its age-related!). Also airport transportation – something that not all delegates use.

In summary, I hope the meeting will continue in the current format as long as there is interest in the international HPB community to run it. The present size is ideal and the restriction to a single hotel is essential to allow the sort of interactions between delegates that we have at present. Many feel that this size of meeting is optimal and we will probably elect to limit registration to around 100 on a first come basis. This will maintain the unique aspect of the meeting, valued by all who attend.

The 2018 ALPS meeting will be held from 31 January – 3 February with pre- and post-meeting attendance possible. Details will be announced shortly.

Professor John Primrose

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