Brigham and Women's Hospital Department of Surgery Harvard Medical School External Review 2017-2021

Exemplary Publications Mittendorf EA, Zhang H, Barrios CH, Saji S, Jung KH, Hegg R, Koehler A, Sohn J, Iwata H, Telli ML, Ferrario C, Punie K, Penault-Llorca F, Patel S, Duc AN, Liste-Hermoso M, Maiya V, Molinero L, Chui SY, Harbeck N. Neoadjuvant Atezolizumab in Combination with Sequential Nab-Paclitaxel and Anthracycline-Based Chemotherapy Versus Placebo and Chemotherapy in Patients with Early-Stage Triple-Negative Breast Cancer (Impassion031): A Randomized, Double-Blind, Phase 3 Trial. Lancet Oncology. 2020 Oct 10;396(10257):1090-1100. This article was published in a high-impact journal (Impact Factor is greater than 60) and reports on a surgeon-led phase III trial. Ritter JL, Zhu Z, Thai TC, Mahadevan NR, Mertins P, Knelson EH, Piel BP, Han S, Jaffe JD, Carr SA, Barbie DA, Barbie TU. Phosphorylation of RAB7 by TBK1/IKKε Regulates Innate Immune Signaling in Triple- Negative Breast Cancer. Cancer Res. 2020 Jan 1;80(1):44-56. Dr. Barbie’s published article in Cancer Research (Impact Factor is 12.100) led to an R01 grant. Kantor O, King TA, Shak S, Russell CA, Giuliano AE, Hortobagyi GN, Burstein HJ, Winer EP, Dey T, Sparano JA, Mittendorf EA. Expanding Criteria for Prognostic Stage IA in Hormone Receptor-Positive Breast Cancer. J Natl Cancer Inst. 2021 May 19 [Online ahead of print]. Junior faculty member, Olga Kantor, led this research effort, which published in a high-impact journal (Impact Factor is 12.600). Dominici L, Hu J, Zheng Y, Kim HJ, King TA, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Wong JS, Partridge AH, Rosenberg SM. Association of Local Therapy with Quality-of- Life Outcomes in Young Women with Breast Cancer. JAMA Surg. 2021 Oct 1;156(10): e213758. This publication is one in a series of studies reporting patient-reported outcomes from our group. Kantor O, Wakeman M, Weiss A, Wong S, Laws A, Grossmith S, Mittendorf EA, King TA. Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer. Ann Surg Oncol. 2021 Mar;28(3):1358-1367. The article is significant as this topic has become an important focus of our clinical practice. D. EDUCATIONAL ACTIVITIES The division has a robust multidisciplinary breast surgical oncology fellowship program, and since 2016 we have trained two fellows per year (see separate fellowship report for more details). We also include general surgery residents and medical students in our ambulatory and operative clinical care settings, as well as our educational forums. The division hosts a number of annual and monthly education-oriented programs for our faculty, fellows, residents, students, and general clinical and research staff. On a monthly basis, the division has two journal clubs for trainees and faculty — one focused on risk and prevention, and the other on diagnosis, evaluation and multi-disciplinary management of breast cancer. Since 2018, we have also organized a quarterly multidisciplinary breast cancer conference and in 2019, we started a monthly multidisciplinary lecture series. Since 2016, the division has hosted an annual retreat for all breast surgery team members, where we discuss recent successes and challenges and 47

present significant clinical and research efforts. We have included at least one invited speaker from another discipline to engage in multidisciplinary discussions about breast care. Career development and mentorship of junior faculty is a particular focus of the Division of Breast Surgery. Four of the five surgeons joining the division in the last five years were new Brigham graduates. Dr. King and Dr. Mittendorf have established multidisciplinary mentorship committees for each of these young surgeons to facilitate their professional development and research goals (quarterly meetings), as well as sponsorship committees for mid-level faculty. E. CURRENT CHALLENGES As a division, it is a challenge to continue to maintain high-quality multidisciplinary care in an ever- changing environment, with multiple clinic practice sites and increasing patient and operating room volumes. Additionally, it is difficult to maintain appropriate focus on faculty development for junior staff given the increasing clinical volume. F. VISION AND FUTURE OPPORTUNITIES In the coming years, we aim to optimize multidisciplinary clinical practice and realize the full potential of newly established clinical programs, such as the DCIS Program, so we may continue to provide expert, specialized care to all patients diagnosed with breast cancer or who experience a breast issue. We will work toward expanding our research portfolio to include more prospective investigator-initiated clinical trials and increase our clinical trial accrual across all ambulatory locations. Our division is deeply committed to education and mentorship, and we will continue our efforts to educate our trainees and support faculty development and promotions. 48

Cardiac Surgery A. OVERVIEW Brigham and Women’s Hospital has a rich history of cardiac surgical innovation dating back almost a century; in 1923, Elliot Cutler, MD, performed the world’s first heart valve operation. The Brigham remained at the forefront of valvular heart disease throughout the next six decades: • 1948 - First mitral valve surgical series. • 1970s - First use of stented porcine heterografts for valve replacement. • 1980s - Initiation of minimally invasive valvular surgery. More recently, the Brigham has developed and innovated in the field of transplantation and the management of end-stage heart disease: • 1984 - First heart transplant program in New England. • 1995 - First heart-lung transplantation in New England. • 1998 - New England’s first hospital to discharge a patient with mechanical heart pumps. • 2018 - New England’s first heart-lung transplant in a patient on advanced mechanical circulatory support in the form of extra-corporeal mechanical oxygenation (ECMO). • 2021 - New England’s first totally thoracoscopic left atrial MAZE procedure. This tradition of innovation continues to the present day. The cardiac surgery service currently provides comprehensive, high quality, state-of-the-art, surgery for patients suffering from: • cardiac valvular pathology • coronary arterial disease • pericardial disease • cardiac arrhythmias • adult congenital heart disease • inherited and acquired cardiomyopathies • thoracic aortic diseases The primary service consists of a collaborative team of surgeons, physician assistants, nurses and intensivists working closely with colleagues from Cardiology, Anesthesia, Vascular and Endovascular Surgery, Radiology, and allied health professionals (pharmacy, social work, physiotherapy) to care for the patient in a wholistic manner, with empathy and compassion for both patients and their families. All care is provided within the Shapiro Cardiovascular Building, where dedicated rooms in the operating suite, cardiac surgery specific intensive care and step-down units, and specialized hybrid operating and 49

catheterization laboratory rooms all function seamlessly to foster an environment of multidisciplinary collaboration. In 2021, The Division of Cardiac Surgery was combined with the Division of Thoracic Surgery. Raphael Bueno, MD, serves as chief of the Division of Thoracic and Cardiac Surgery. Hari Mallidi, MD, oversees the cardiac surgery clinical service that includes a team performing thousands of surgeries and procedures every year. The division is renowned for its innovative care and leadership in the fields of cardiac surgery, transplantation and minimally invasive surgical techniques. Over the past five years, the service has provided care for approximately 1,500 patients per year across the operating rooms and catheterization laboratories. The service has built a reputation for providing innovative, minimally invasive care of patients. This commitment to the development and implementation of less invasive methods for managing surgical heart disease has kept the service a destination for patients regionally, nationally and internationally. B. CLINICAL SERVICES Led by Dr. Mallidi, the clinical cardiac surgery service is comprised of nine faculty members located at two sites. The Brigham is the main site of clinical activity and supports the clinical, research and teaching missions of the division. There are also two surgeons located at Cape Cod Hospital, which serves that community as the only cardiac surgical program in the area. In FY 2021, faculty performed 1,091 cases in the operating room and 255 cases in the Cath lab at the Brigham. Faculty members performed 107 cases in the operating room and 177 cases in the Cath lab at Cape Cod Hospital. In addition, faculty members served the community by maintaining outpatient clinics at two additional locations: Kent Hospital in Rhode Island and Hopedale Cardiovascular Associates in Upton, MA, where 154 patients were seen and evaluated for surgery in FY 2021. The clinical service is structured for care to be provided within expert niche domains, under the rubric of separate anatomically or disease-focused sections. There are currently six sections within the service: Coronary Artery Disease, Valvular Heart Disease, Thoracic Aortic Disease, End-Stage Organ Failure (transplantation and mechanical circulatory support), Critical Care and Adult Congenital Heart Disease. These sections all have chiefs whose responsibility is to ensure quality, outcomes, innovation, education, mentorship and CME activity. 50

Key Accomplishments • Expansion and growth of the structural heart program, with close collaboration with Cardiology via the Heart and Vascular Center. • Development of an integrated I6 direct cardiac track ACGME-approved residency in Cardiac Surgery. • Funding procured through philanthropy for the establishment of a dedicated clinical research fellowship. • Initiation of the first percutaneous tricuspid valve intervention program in New England. • Re-initiation of an active heart-lung transplant program. • Significant expansion of ECMO program/capacity and implementation of care model changes emphasizing multidisciplinary management of these complex patients. • Initiation of the first totally thoracoscopic left atrial Maze (TT-Maze) program for the management of patients with atrial fibrillation in New England. • Initiation of a comprehensive adult congenital heart surgery program in close collaboration with surgeons from Boston Children’s Hospital and cardiologists from the Boston Adult Congenital Heart Program. • Initiation of a comprehensive transplant surgical training program focused on the care and management of end-stage heart failure patients. Members of the cardiac surgical service are part of several multidisciplinary collaborations within the Department of Surgery and outside the department. Surgeons and cardiologists work closely together in the Structural Heart Program, with a complement of highly trained and skilled operators capable of performing all aspects of these procedures. The program was initiated by the late Michael J. Davidson, MD, one of the first hybrid cardiac surgeons in the world who was fully trained in both open cardiac surgery and in interventional cardiology. Surgeons and cardiologists work together in the Center for Advanced Heart Diseases within the Heart and Vascular Center in caring for patients with end-stage heart disease. There is close collaboration with cardiologists, intensivists, pulmonologists and surgeons in the ECMO program, both within the Brigham and across New England, as part of a regional collaborative established to better manage ECMO resources. The Brigham Cardiac Surgery Clinical Service also functions within the construct of the Mass General Brigham Cardiac Surgery Clinical Service, which is led by Thoralf Sundt, MD. This effort is targeted at harmonizing the cardiac surgery work including approaches to supporting services and protocols in cardiac anesthesiology, perfusion services, critical care protocols, and durable medical goods. The goals of this work are to improve patient access to MGB cardiac surgery, to decrease total medical expense, to preserve quality and patient safety, and to increase the volume of high-value, high-complexity patient care. This work has been initiated over the past 18 months, and is ongoing. 51

C. RESEARCH ACTIVITIES Research is an integral part of the division and is based around a community of PhD and medical experts in various arenas, from molecular and cellular biology to bioengineering. Faculty members in the division are involved in close to 30 clinical trials, including major international and multicenter clinical trials, and numerous externally funded research projects in collaboration with investigators within the Brigham community and beyond. Current research efforts in the division focus on: • Thoracic aortic disease, aortic aneurysm biology, biomechanics and clinical progression. • Surgical outcomes of cardiac procedures, including coronary artery bypass, valve repair/replacement and minimally invasive procedures • Clinical trials evaluating new surgical techniques and new devices • Correlative studies connecting preoperative patient status with outcomes of heart transplantation The aim of clinical research is to demonstrate results and trends of new therapeutic procedures and compare interventions in cardiac surgery through retrospective and prospective studies that will help establish more effective treatments and therapeutic protocols. Work includes literature reviews, sampling and processing of patient data and simple statistical (descriptive) analysis. Key Grants Name of study: MDIC Work Order: AltaValve Early Feasibility Study Protocol PI: Tsuyoshi Kaneko Funding source: 4C Medical Technologies, Inc. Funding amount: $98,209 Brief description of the study w/goals and objectives: This trial assesses the efficacy of the novel transcatheter mitral valve replacement device. This is a single-arm, early feasibility study that enrolls high-risk surgical patients. The Brigham is one of only 10 sites in the country performing the trial. Name of study: A Pilot Study Examining Conscious Awareness and Cognitive Experiences During Deep Hypothermic Circulatory Arrest PI: Ashraf Sabe, MD Funding source: New York University School of Medicine Funding amount: $32,775 Brief description of the study w/goals and objectives: Patients who require aortic arch surgery must be systemically cooled and their circulation is arrested temporarily to allow for repair. This study seeks to examine whether there is any conscious awareness during this time in the surgery through a series of cognitive challenges intraoperatively and questionnaires postoperatively. 52

Name of study: CTA: Transcatheter Replacement of Stenotic Aortic Valve through Implantation of ACURATE in Subjects Indicated for TAVR PI: Tsuyoshi Kaneko, MD Funding source: Boston Scientific Corporation Funding amount: $32,221 Brief description of the study w/goals and objectives: This trial uses the novel transcatheter aortic valve replacement device and is compared to the currently approved devices. This is a national pivotal trial pre-FDA approval. Name of study: CTA: A Prospective, Randomized, Active (Warfarin) Controlled, Parallel-Arm Clinical Trial to Determine if Patients with an On-X Aortic Valve can be Maintained Safely and Effectively on the Factor Xa Inhibitor Apixaban PI: Ashraf Sabe, MD Funding source: CryoLife, Inc. Funding amount: $34,024 Brief description of the study w/goals and objectives: A national prospective, randomized trial evaluating whether Apixiban can be used as a non-inferior alternate to Warfarin in patients after mechanical aortic valve placement with the On-X aortic valve. Name of study: Structural and Endovascular Cardiac Surgery Fellowship — 2021 TSF Michael Davidson Fellowship Award PI: William Shi, MBBS Funding source: The Thoracic Surgery Foundation Funding amount: $50,000 Brief description of the study w/goals and objectives: The TSF Michael Davidson Structural Heart Fellowship enables a junior cardiac surgeon to receive unique, specialized training in performing transcatheter heart valve procedures. The award not only enables surgeons to become clinically and technically proficient, but also facilitates the conduct of high-impact outcomes research related to heart valve disease. Exemplary Publications Rogers JG, Pagani FD, Tatooles AJ, Bhat G, Slaughter MS, Birks EJ, Boyce SW, Najjar SS, Jeevanandam V, Anderson AS, Gregoric ID, Mallidi H, Leadley K, Aaronson KD, Frazier OH, Milano CA. Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure. NEJM. 2017; 376: 451-460. Makkar RR, Yoon SH, Leon MB, Chakravarty T, Rinaldi M, Shah PB, Skipper ER, Thourani VH, Babaliaros V, Cheng W, Trento A, Vemulapalli S, Kapadia SR, Kodali S, Mack MJ, Tang GHL, Kaneko T. Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke. JAMA. 2019; 321:2193-2202. 53

Woolley AE, Singh SK, Goldberg HJ, Mallidi HR, Givertz MM, Mehra MR, Coppolino A, Kusztos AE, Johnson ME, Chen K, Haddad EA, FAnikos J, Harrington DP, Camp PC, Baden LR, DONATE HCV Trial Team. Heart and Lung Transplants from HCV-Infected Donors to Uninfected Recipients. NEJM. 2019; 380: 1606- 1617. Hirji SA, Percy ED, McGurk S, Malarczyk A, Harloff MT, Yazdchi F, Sabe AA, Bapat VN, Tang GHL, Bhatt DL, Thourani VH, Leon MB, O'Gara P, Shah PB, Kaneko T. Incidence, Characteristics, Predictors, and Outcomes of Surgical Explantation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020; 76:1848-1859. Kaneko T, Hirji S, Zaid S, Lange R, Kempert J, Conradi L, Hagl C, Borger M, Taramasso M, Nguyen T, Aliwadi G, Shah A, Smith R, Anselmi A, Romano M, Ali WB, Ramlawi B, Grubb K, Robinson N, Pirelli L, Chu M, Andreas M, Obadia JF, Gennari M, Garatti A, Tchetche D, Nazif T, Bapat V, Modine T, Denti P, Tang G. CUTTING-EDGE Investigators. JACC Cardiovasc Interv. 2021 Sep 27; 14(18): 2010-2021. PMID: 34556275 D. EDUCATIONAL ACTIVITIES The service is committed to the ongoing education of nurses, physician assistants, residents/fellows, patients and their families. Educational programs tailored to the needs of the various constituencies have been designed. The faculty believes in the importance of ongoing medical education and is committed to providing the lectures, small group-based seminars, hands-on-training opportunities and ongoing informal educational sessions needed to ensure that all members of the service can provide the cutting-edge care that patients require. Under Dr. Bueno’s direction, the division offers the following residency and fellowship programs to train the next generation of cardiac surgeons. More information on the individual programs can be found in Appendix 2 and 3. • 5-2 Thoracic (Cardiothoracic) Residency Program – Develops the knowledge and skills needed to perform as academic thoracic and cardiac surgeons at the highest level, through a diverse array of supervised operative and non-operative experiences. Residents gain surgical and clinical skills leading to eligibility for American Board of Thoracic Surgery certification, with emphasis on the diagnosis of cardiothoracic disease, assessment of operative risk and application of new technologies to tailor surgical intervention to individual patients. • Integrated Thoracic Residency – Provides an optimum number of diverse adult cardiac, congenital cardiac and general thoracic operative and non-operative experiences under supervision, to gain surgical and clinical skills leading to eligibility for American Board of Thoracic Surgery certification. Each of the three principal services in this training program (Cardiac Surgery, Thoracic Surgery and Pediatric Cardiac Surgery) has state-of-the-art dedicated facilities for clinical and laboratory research. 54

• Cardiothoracic Surgery Transplant Fellowship – Prepares trainees in the highly complex and advanced discipline of end-organ heart and lung disease management, with four principal disciplines (Heart Transplant, Lung Transplant, Mechanical Circulatory Support, ECMO). • Endovascular Fellowship – Offers fellows the preparation for leadership roles in catheter-based structural cardiac programs. The fellow is expected to be involved in a diverse and busy clinical caseload (under direct supervision of Cardiology and Cardiac Surgery attendings), and structural cardiac research. The goal of the fellowship is to train fellows pursuing academic careers, with a clinical and research emphasis. • Adult Cardiac Surgery Fellowship – Provides training to cardiothoracic surgeons who are looking for further training in the management of patients on the cardiac surgery service. The fellowship provides opportunities to become experienced in the oversight of a complex service, with primary responsibility for the evaluation of emergency cases at night, both in the emergency room and in the catheterization lab. The fellow develops an in-depth knowledge of hemodynamic management in critical care and becomes efficient in interpreting echocardiogram (ECHO), computed tomography (CT), catheterization studies, and the principles of management of coronary disease, valvular heart disease and diseases of the aorta. E. CURRENT CHALLENGES The cardiac surgical service at Brigham and Women’s Hospital is in the midst of revamping, reimagining and expanding the clinical service. Potential barriers to success include challenges related to overall hospital bed capacity and limitations on being able to accept and transfer acutely ill patients requiring urgent and emergent care. The challenges posed by the emergence of COVID-19 have been widespread. Hiring and retaining allied health services providers (surgically skilled cardiac physician assistants, perfusionists, intensive care providers, cardiac surgical nurses, etc.) has become very difficult. The rate of burnout within the specialty is high. Expansion of the cardiac surgical service will require the realization of the necessity for increased use of newer technologies, such as novel therapeutic approaches in the Cath lab/hybrid operating room, the increased use of ECMO and other forms of temporary mechanical circulatory support, and the expanded use of thoracoscopic and/or surgical techniques utilizing the Da Vinci robot. Given the greater complexity of care for a sicker cohort of patients, the ability to hire and retain highly specialized individuals throughout the cardiac surgical service will require investment from the hospital. The growth and development of the cardiac surgical service will also present challenges for the training and education of new residents and fellows. The techniques and procedures that will be expanded are well beyond the capacity of the general cardiac surgical trainee. There will be an increased need for graduates of the surgical training program to spend dedicated time beyond the basic residency program. This mandates the need for advanced surgical fellowships and funding mechanisms beyond what is currently in place. We have some of the best trainees in the world and will continue to attract interest 55

from the best and brightest. However, mechanisms to ensure that we are able to train the next generation in the newer approaches will have to be assured. F. VISION AND FUTURE OPPORTUNITIES The goal is for Brigham Cardiac Surgery to become the top ranked regional, national and international program in terms of clinical quality, access and innovation. We are doing this by expanding multidisciplinary, specialized diagnosis-based programs for patient care, which are linked to collaborative research efforts that lead to innovation. 56

General and Gastrointestinal Surgery A. OVERVIEW The Division of General and Gastrointestinal Surgery (GGI) is one of the largest divisions in the Department of Surgery and has undergone significant changes over the past five years. In 2018, the Department of Surgery restructured its divisions and moved the section of Endocrine Surgery, previously under the Division of GGI, to the Division of Surgical Oncology. As part of the transition, our chief of 19 years, Francis D. Moore, Jr., MD, who was a member of Endocrine Surgery, became a member of the Division of Surgical Oncology, prompting the search for a new GGI chief. Ali Tavakkoli, MD, a bariatric and minimally invasive surgeon in the division, was appointed the interim chief of the restructured division in October 2018. Following a competitive national search, Dr. Tavakkoli was officially named the chief of the division in December 2019. In 2020, the division faced many challenges due to the COVID-19 pandemic, but adapted well. And as the data below will show, it has become a stronger and more successful division. The division currently has 22 surgical faculty members who provide inpatient clinical care at four sites, including Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, South Shore Hospital and Kent Hospital. In addition to local campuses in Boston and Jamaica Plain, outpatient services are also provided at five other ambulatory sites (Chestnut Hill, Foxborough, Pembroke, Westwood and Weymouth). The Foxborough outpatient clinic facility has also provided us the opportunity to perform day surgery cases in that area. The division’s clinical activity focuses on three areas: • Metabolic and Bariatric Surgery • Colon and Rectal Surgery • Minimally Invasive & General Surgery Division faculty members have important departmental and institutional leadership roles: • Ronald Bleday, MD, vice chair for Quality and Patient Safety, Department of Surgery • Melissa Murphy, MD, MPH, chief of Surgery, Kent Hospital • Malcolm K. Robinson, MD, vice chair for Clinical Operations, Department of Surgery and surgical director, Perioperative Services, Brigham and Women’s Hospital • Douglas S. Smink, MD, MPH, vice chair for Education in the Department and chief of Surgery, Brigham and Women’s Faulkner Hospital • Thomas C. Tsai, MD, MPH, director of Clinical Care Redesign, Department of Surgery, Brigham and Women’s Hospital 57

The division has had an incredibly successful five years and has been very active clinically and academically. This report will highlight some of our achievements and future goals, but does not include the dozens of academic papers written by our group; the local, national and international teaching activities; the many local and national leadership roles that division faculty have; and the dedication to education and teaching that our faculty demonstrate on a daily basis. B. CLINICAL SERVICES Inpatient Cases by Section 4000 1251 1225 1136 1110 1178 3500 480 493 512 518 602 3000 198 223 1753 1637 1635 2500 2020 2021 2000 1848 1751 2019 1500 1000 2017 2018 500 0 Colorectal Endocrine General MIS/Bariatrics Metabolic and Bariatric Surgery As of January 2021, the bariatric program formally aligned with the bariatric endoscopy and medical weight management programs at the Brigham, to create an integrated and comprehensive program to treat the chronic disease of obesity. The Center for Weight Management and Wellness (CWMW) is a full- service program that offers innovative surgical operations and endoscopic treatments, medications and patient-centered care plans delivered by obesity specialists. Over the past five years we have worked closely with South Shore Hospital (SSH) to provide bariatric surgery services. This effort has been led by Neil Ghushe, MD, who has created an outstanding and rapidly expanding program at that institution. As a result, the program has seen a significant increase in surgical volume, with more than 660 primary and revisional bariatric cases performed in FY21 across all sites. Within the Mass General Brigham Bariatric Collaborative, our team led the way in reducing the number of opioid pills prescribed to patients at discharge. After demonstrating that many of our patients did not use most of their prescribed narcotics, we have reduced the number of prescribed pills from 30 to eight. 58

Through the adoption of the Enhanced Recovery After Surgery (ERAS) pathway, better management of postoperative nausea and patient education at all sites (BWH, BWFH and SSH), we have been able to reduce length of stay following sleeve gastrectomy procedures, with at least 75% of patients being discharged the first day after operation. The team has also developed a digital bariatric patient intake form that has created a prospective database of patient data, including patient reported outcome measures (PROMs), which have been the foundation behind several research projects and quality improvement initiatives. The program has also initiated two regular multidisciplinary conferences in close collaboration with our bariatric endoscopists and medical weight management team. This includes a monthly didactic teaching conference for fellows, faculty and residents, as well as a biweekly complex case review that is also attended by the dietitians, psychologists, and endocrinologists to discuss and help provide optimal treatment recommendations for many complex patients, who come from New England and beyond. Bariatric Case Volume Trends (All Locations) 700 650 20 600 537 555 53 3156 500 38 470 1245 489 54 49 526 14 18 400 44 50 55 38 27 300 200 401 467 368 389 100 0 FY18 FY19 FY20 FY21 FY17 Sleeve Gastric Bypass Band Band Removal Conversion Revision Total Average Length of Stay for Sleeve Gastrectomy for Brigham Health 2.50 2.07 1.98 1.86 1.77 1.90 2.00 1.73 1.54 1.57 1.50 Days 1.40 1.26 1.00 0.50 0.00 FY19 Q1 FY19 Q2 FY19 Q3 FY19 Q4 FY20 Q1 FY20 Q2 FY20 Q3 FY20 Q4 FY21 Q1 FY21 Q2 59

Colon and Rectal Surgery The section of colon and rectal surgery has had a productive and energetic several years, including hiring James Yoo, MD, who previously held the role of chief of Colon and Rectal Surgery at Tufts Medical Center. He brings not only clinical expertise, but a basic science lab that investigates causes and treatments of colonic mucosa inflammation. The group has expanded in specific clinical areas. Our robotic surgery program was established through the efforts of Joel Goldberg, MD, and now Jennifer Irani, MD. We are currently performing more than 125 cases per year, which is the leading program in New England in volume of cases. The robotic approach is not only used for cases of colon and rectal cancer, but also for care of patients with inflammatory bowel disease, using robotic techniques to perform ileoanal anastomosis surgery or J- pouch surgery for ulcerative colitis, as well as ileocolic resections for Crohn’s disease. Colectomy Volume 600 191 226 180 215 500 209 281 231 257 400 2018 2019 2020 2021 300 177 200 100 217 0 2017 Cancer Only Non-Cancer Colectomies Over the past 30 years the incidence of anal cancer in the United States has increased by 96% in men and 39% in women, due in part to the HIV epidemic. With the introduction of high resolution anoscopy (HRA) as a more effective clinical tool to diagnose and treat precancerous lesions of the anus, we have developed a collaborative multidisciplinary program for anal dysplasia screening, evaluation and management at the Brigham. The primary collaborators come from the Division of General and GI Surgery (Dr. Bleday and Dr. Yoo) and the Division of Infectious Diseases (Dr. Jennifer Johnson). The clinic has instituted an evidence-based program for the management of anal dysplasia that involves screening and surveillance with the anal pap smear and HRA. We are also working collaboratively with the Departments of Pathology and Dermatology and plan to develop a research program to study this disease process, reduce treatment-related morbidity and decrease the incidence of anal cancer. The Program in Peritoneal Surface Malignancy was established in 2016 and is led by Nelya Melnitchouk, MD, MSc. Multidisciplinary care, including cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC), is offered for patients with peritoneal disease from colorectal and appendiceal 60

primary cancers and also patients who have peritoneal mesothelioma. This program has seen a substantial increase in volume and has been the focus of research by the team. Our colorectal group also led the institution in implementing the ERAS pathway with substantial improvements in patient outcomes. The surgical site infection rate has decreased from over 10% to less than 2.5%; postop cardiac arrhythmia rate has decreased from 5% to 1.5% and length of stay has dropped from a median of six days to three days. These impressive results have led to Mass General Brigham system-wide standardization of colorectal ERAS protocols. We have just added geriatric orders to the set to improve both process and outcome measures for older, frail patients. Finally, in the last two years we have started a robust weekly multidisciplinary colorectal cancer clinical case review, which includes not only the surgical team but also medical oncologists, radiation therapists, radiologists and pathologists. Minimally Invasive and General Surgery Within this group, the focus over the past five years has been the creation of a multidisciplinary Hernia Center, increasing the foregut surgical volume, and the expansion of robotic surgery. In collaboration with the Division of Plastic and Reconstructive Surgery and the Division of Trauma, Burn, and Surgical Critical Care, we created the Comprehensive Hernia Center in 2019. This center draws on the expertise of members in each of those divisions who specialize in hernia care. The goal of the center is to provide interdisciplinary care for patients with complex and recurrent hernias, with referrals from all over New England. We have partnered with clinicians in Radiology, Infectious Disease, Wound Care, Endocrinology and Weight Management to address the many medical and surgical issues faced by these complex patients, and are focusing on further expansion and marketing of this clinic. 61

Paraesophageal Hernia Ventral, Umbilical, Incisional 200 800 150 600 400 100 200 50 0 2017 2018 2019 2020 2021 0 2017 2018 2019 2020 2021 Gallbladder Inguinal, Femoral 600 500 300 400 250 300 200 200 150 100 100 0 50 2017 2018 2019 2020 2021 0 2017 2018 2019 2020 2021 To ensure that the team has access to all surgical techniques for management of complex hernias, we have focused on developing a robotic abdominal wall hernia program, led by Eric Sheu, MD. Over the past two years this program has seen significant growth and notable landmarks, including performance of the first robotic abdominal wall reconstruction (transversus abdominus release) in the metro Boston area. The robotics program has now expanded to foregut surgery, an area where we have significant growth in referrals for not only primary but also revisional foregut cases, both at the Brigham and at Brigham and Women’s Faulkner Hospital. C. RESEARCH ACTIVITIES The division has ongoing active research programs in basic science, health services and health policy. The Laboratory for Surgical and Metabolic Research, which dates back to the 1950s, has housed the basic science research efforts of the division with Dr. Tavakkoli, Dr. Sheu and Dr. Yoo as current active members. Several of the other faculty, including Dr. Melnitchouk and Dr. Tsai are active members of the Center for Surgery and Public Health, with several national and international research grants on clinical research and health policy. Over the past few years, we have focused on recruiting new faculty members to increase our external funding. We have also developed a program to encourage faculty to submit grants. More support for patient recruitment and access to grant editors have helped improve the success of submitted applications. These efforts have been fruitful as reflected in the number of grants faculty have received, as well as an increase in research funding density. 62

Key Grants Name of study: Role of Meal Timing in Efficacy of Bariatric Surgery in Obese Individuals PI(s): Ali Tavakkoli, MD, and Dr. Scheer Funding source: NIH-National Heart, Lung, and Blood Institute Funding amount: $2,325,000 Brief description of the study w/goals and objectives: The broad goal of this project is to determine whether improvements in the daily pattern of food intake can enhance the beneficial effects of bariatric surgery and improve weight loss in patients who have experienced significant weight gain. Name of study: Development of Synthetic Analogs of a Sleeve Gastrectomy-Induced Metabolite as a Novel Therapy for Type 2 Diabetes and Obesity PI(s): Eric Sheu, MD, PhD Funding source: Q-FASTR Development Grant Funding amount: $300,000 Brief description of the study w/goals and objectives: The goal of this project is to develop and test synthetic analogs of a novel gut restricted metabolite found after sleeve gastrectomy for treatment of diabetes and obesity. Name of study: Shared Decision Making for Bariatric Surgery in Patients with Severe Obesity PI(s): Arterburn (Dr. Tavakkoli on the Executive Stakeholder Advisory Group) Funding source: PCORI Funding amount: $1,497,740 Brief description of the study w/goals and objectives: This project aims to use a decision aid and test its utility in helping patients decide on the right bariatric operation for them. Name of study: Update to the HGHI COVID-19 U.S. Hospital Capacity Model: ICU Surge, Post-Acute Care Beds, and Survey of Mechanical Ventilator Supply PI(s): Thomas Tsai, MD, MPH Funding source: Massachusetts Consortium on Pathogen Readiness/Mass Life Sciences Center Funding amount: $337,219 Brief description of the study w/goals and objectives: This project uses CDC COVID-NET and HHS Protect data on hospitalizations to provide real-time monitoring of the effect of COVID-19 hospitalizations on inpatient capacity in the U.S. Name of study: A Microbiome-Dependent Bile Acid Metabolite Improves Type 2 Diabetes PI(s): Eric Sheu, MD, PhD Funding source: NIH Funding amount: $3,340,983 Brief description of the study w/goals and objectives: The goal of this project is to investigate the metabolic effects and biosynthetic pathways of cholic acid-7-sulfate and this pathway’s role in the metabolic actions of bariatric surgery. 63

Name of study: Evaluation of Cultural Dexterity Training Program for Surgeons: The PACTS Trial National Institute on Minority Health and Health Disparities PI(s): Douglas Smink, MD, MPH Funding source: NIH Funding amount: $3,400,000 Brief description of the study w/goals and objectives: The trial will test the effectiveness of a novel cultural dexterity curriculum, the Provider Awareness and Cultural Dexterity Toolkit for Surgeons (PACTS), in improving surgical residents’ knowledge, attitudes and skills in caring for patients of diverse cultural backgrounds through a multicenter trial. Exemplary Publications Lee Y, Deelman T, Chen K, Lin D, Tavakkoli A*, Karp J (* co-senior author). Therapeutic Luminal Coating of the Intestine. Nature Biomaterial. 2018 Sep;17(9):834-842 (Altmetric Score: 703) Lyu HG, David JS, Scully RE, Melnitchouk N. Association of Domestic Responsibilities with Career Satisfaction for Physician Mothers in Procedural vs Nonprocedural Fields. JAMA Surgery. 2019;154(8):689-695 (Altmetric Score: 285) Courcoulas A, Coley RY, Clark JM, McBride CL, Cirelli E, McTigue K, Arterburn D, Coleman KJ, Wellman R, Anau J, Toh S, Janning CD, Cook AJ, Williams N, Sturtevant JL, Horgan C, Tavakkoli A. Interventions and Operations Five Years After Bariatric Surgery in a National Cohort: The PCORnet Bariatric Study. JAMA Surgery. 2020;155(3):194-204 (Altmetric Score: 150) Chaudhari SB, Harris DA, Aliakbarian H, Luo JN, Henke MT, Subramaniam R, Vernon AH, Tavakkoli A, Sheu EG*, Devlin AS (* co-senior author). Bariatric Surgery Reveals a Gut-Restricted TGR5 Agonist with Anti-Diabetic Effects. Nature Chemical Biology. 2021; 17, 20–29 (Altmetric Score: 24) Wellenius GA, Vispute S, Espinosa V, Fabrikant A, Tsai TC, Hennessy J, Dai A, Williams B, Gadepalli K, Boulanger A, Pearce A, Kamath C, Schlosberg A, Bendebury C, Mandayam C, Stanton C, Bavadekar S, Pluntke C, Desfontaines D, Jacobson BH, Armstrong Z, Gipson B, Wilson R, Widdowson A, Chou K, Oplinger A, Shekel T, Jha AK, Gabrilovich E. Impacts of Social Distancing Policies on Mobility and COVID- 19 Case Growth in the U.S. Nature Communication. 2021 May 25;12(1):3118 (Altmetric Score: 608) Rangel E, Castillo-Angeles M, Rae Easter S, Atkinson R, Gosain A, Hu Y, Cooper Z, Dey T, Kim E. Incidence of Infertility and Pregnancy Complications in U.S. Female Surgeons. JAMA Surgery. 2021;156(10):905- 915 (Altmetric Score: 545) 64

D. EDUCATIONAL ACTIVITIES The division has an ACGME-accredited colorectal fellowship and a Fellowship Council-accredited program in minimally invasive and bariatric surgery. Dr. Melnitchouk became the program director of the colorectal fellowship in 2019. The fellowship offers outstanding and broad training in management of benign and malignant colorectal diseases and anal disorders, using open laparoscopic, endoscopic and robotic techniques. The graduates are all certified and proficient in robotic surgery. Dr. Tavakkoli has been the program director for the minimally invasive and bariatric surgery fellowship since 2014. The program offers broad training in complex hernia, foregut, general GI and bariatric surgery, using both laparoscopic and robotic approaches. The program has become increasingly competitive with over 100 applicants for one training position. The fellows receive academic and career mentorship not only from their specialty faculty, but also from divisional and departmental leadership. They are academically productive during the year, with expectations to submit an abstract to national meetings and publish the relevant data. The faculty is also committed to resident and medical student education with several members having educational leadership roles within the department. Dr. Smink is vice chair for Education, Dr. Irani is an associate program director for the general surgery residency and Dr. Rangel is associate clerkship director for medical students. Several members of our faculty have received departmental, institutional and national teaching and mentoring awards including: • Dr. Shoji: 2018 Donald Matson Resident Teaching Award, 2019 HMS Leonard Tow Humanism in Medicine Award and 2020 Brigham Clinical Teacher Award • Dr. Kenney: 2017 Wilson Chief Resident Award and 2021 Brigham Clinical Teacher Award • Dr. Smink: 2019 ACGME Parker J. Palmer Courage to Teach Award and 2020 Mass General Brigham Champion of Education Award • Dr. Ashley: 2021 Brigham Senior Faculty Mentor Award and 2021 American College of Surgeons Surgical Forum Dedicatee E. CURRENT CHALLENGES The division has seen a substantial increase in new patient volume, with increasing visit numbers at our community-based sites. From an operations perspective, growing practices in the community present challenges, including flow of patient information and nonstandard responsibilities across sites. We are monitoring and addressing these challenges. 65

With increasing utilization of virtual visits, the clinic rental models have not shifted to accommodate this change, causing misalignment between the division and the community practice leadership, and thus limiting growth. Access to the OR and OR efficiency have been major issues, which have impacted faculty morale and number of cases booked per session. Institutional and departmental leadership are aware, and there is a major focus on improving these inefficiencies. For our support staff, the COVID-19 pandemic and the introduction of hybrid work models present another challenge. New technology has enabled the staff to work remotely, yet the adoption of these tools has created new challenges for communication and information sharing. The division continues to revise and enhance its hybrid work models and we foresee continued evolution in the years to come. F. VISION AND FUTURE OPPORTUNITIES The Division of General and GI Surgery plans to recruit additional faculty in the next one to two years to meet capacity goals, while improving efficiency and patient experience across all sites. There is an opportunity to further leverage virtual visits to expand our regional presence. We will continue to encourage faculty to become licensed in New England states for continued practice growth and to meet current patient needs. Patient experience is the foundation of our work, and we will use our new feedback system, NRC, to make improvements. Faculty development remains of great importance, as it has over the past five years. We encourage all faculty to engage with national and local societies and organizations and have made commitments to support them in pursuing their academic and research goals. The increasing integration of services resulting from the creation of the Brigham and Mass General Brigham service lines provides opportunities for growth and leadership development. 66

Oral Medicine A. OVERVIEW The Division of Oral Medicine focuses specifically on specialty oral medicine care and limited essential/medically necessary dental services to medically complex patients. The division represents one of the largest oral medicine programs in the United States, providing expert care for patients who are referred from within and outside of the Mass General Brigham system with oral mucosal diseases, salivary gland disorders and orofacial pain conditions. Led by division chief Nathaniel Treister, DMD, DMSc, the division is made up of 4.4 FTE faculty members, including two who have recently joined the division and taken on leadership roles. Piamkamon Vacharotayangul, DDS, PhD, joined the division as residency director in late 2020, and Kentaro Ikeda, DDS, MPH, joined the division in early 2021 as clinical director. The current Oral Medicine service is a non-surgical program that was historically embedded in the Department of Surgery as part of the Division of Oral Surgery, which no longer exists at BWH. The medical service of that former division still resides within the Brigham Department of Surgery today as the Division of Oral Medicine. Key Accomplishments • Increased clinical volume by 37% • Established a Pediatric Oral Medicine Clinic at Boston Children’s Hospital • Updated and restructured the Dental Screening and Clearance Program for high-risk cancer/transplant patients • Established an Oral Medicine and Oral Oncology Clinic at Dana-Farber Cancer Institute (DFCI) B. CLINICAL SERVICES The Oral Medicine faculty evaluate and treat patients for a wide range of oral medicine conditions, including oral mucosal diseases and orofacial pain. Common oral mucosal diseases managed by the oral medicine faculty include: • infectious diseases such as HSV and candidiasis • immune-mediated/inflammatory conditions such as pemphigus, pemphigoid and lichen planus • oral manifestations of systemic diseases such as Crohn disease and SLE • oral complications of medical treatments such as GVHD and mucositis • malignant and premalignant lesions 67

Common orofacial pain conditions seen by the oral medicine faculty include: • temporomandibular disorders • myofascial pain • neuropathic pain • burning mouth syndrome The ability to provide a broad-spectrum approach at a high level of sophistication, across BWH, DFCI and Boston Children’s Hospital, is a special attribute of this division. C. RESEARCH ACTIVITIES The division manages a research portfolio of NIH grants for which it is either the leading site or a contracted site. Divisional research also includes industry sponsored contracts, as well as internally funded or unfunded projects. All the division’s faculty participate in research. Oral medicine residents and, at times, students from the Harvard School of Dental Medicine (HSDM) are engaged by the faculty in research projects. Some of these projects are collaborative multidisciplinary projects within the MGB system. Others include colleagues at DFCI and at other institutions, nationally and internationally. Key Grants Name of study: Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients PI: Nathaniel Treister, DMD, DMSc Funding source: NIDCR Funding amount: $616,075 Brief description of the study w/goals and objectives: Cohort study to study dental outcomes following chemoradiation therapy for head and neck cancers. Name of study: Extraorally Delivered Low Level Light Therapy for Prevention of Oropharyngeal Mucositis in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation PI: Nathaniel Treister, DMD, DMSc Funding source: NIDCR Funding amount: $408,924 Brief description of the study w/goals and objectives: A non-inferiority study to test Gelclair (a novel agent) against the standard of care treatment for oral mucositis (Magic Mouthwash) in patients undergoing allogeneic hematopoietic stem cell transplantation. 68

Name of study: Long-Term Oral Health Outcomes in the Chronic GVHD Consortium PI(s): Herve Sroussi, DMD, PhD, and Nathaniel Treister, DMD, DMSc Funding source: NIDCR Funding amount: $3,703,276 Brief description of the study w/goals and objectives: Cohort study to evaluate long-term oral health outcomes in patients with chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation. Name of study: Oral Hygiene, Periodontal Disease and Infective Endocarditis PI: Vidya Sankar, DMD Funding source: NIDCR Funding amount: $652,653 Brief description of the study w/goals and objectives: Investigation of the association between periodontal disease, periodontal bacteria and community acquired infection endocarditis. Exemplary Publications Sroussi HY, Epstein JB, Bensadoun RJ, Saunders DP, Lalla RV, Migliorati CA, Heaivilin N, Zumsteg ZS. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017 Dec;6(12):2918-2931. Villa A, Menon RS, Kerr AR, de Abreu Alves F, Guollo A, Ojeda D, Woo S. Proliferative leukoplakia: proposed new clinical diagnostic criteria. Oral Dis 2018; 24:749-760. Li CC, Almazrooa S, Carvo I, Salcines A, Woo SB. Architectural alterations in oral epithelial dysplasia are similar in unifocal and proliferative leukoplakia. Head Neck Pathol 2021; 15:443-460. Klein B, Alves F, Velho J, Vacharotayangul P, Hanna G, LeBoeuf N, Shazib A, Villa A, Woo S, Sroussi H, Sonis S, Treister N. Oral manifestations of immune-related adverse events in cancer patients treated with immune checkpoint inhibitors. Oral Diseases 2021; accepted for publication Treister NS, Brennan MT, Sollecito TP, Schmidt BL, Patton LL, Mitchell B, Haddad RI, Tishler RB, Lin A, Shadick R, Hodges JS, Lalla RV. Exposed bone in patients with head and neck cancer treated with radiation therapy: an analysis of the observational study of dental outcomes in head and neck cancer patients (OraRad). Cancer. 2021; in press Yaroslavsky A, Juliano A, Adnan A, Selting W, Iorizzo T, Carroll J, Sonis S, Duncan C, London W, Treister N. Validation of a Monte Carlo Modeling Based Dosimetry of Extraoral Photobiomodulation. Diagnostics. 2021; in press 69

D. EDUCATIONAL ACTIVITIES The Oral Medicine Residency Program is an intensive 36-month training program, which culminates in the awarding of a clinical certificate in oral medicine. The residency program has evolved and is transitioning from hybrid tracks (stipend/tuition) to a single, certificate only track. The division provides critical clinical educational experiences for the oral medicine residents, HSDM dental students, general practice dental residents (HSDM programs at both Cambridge Health Alliance and MGH), and dermatology/other assorted medical trainees, who all rotate through our Brigham and DFCI clinics. For more information about the residency, please see Appendix 2. In July 2019, the residency program received a development gift named the “Oral Medicine Education Fund” from a grateful patient. This fund provides additional support to oral medicine residents (such as enabling them to attend and present at conferences) so they may expand their educational and professional development. Faculty and residents often work together to give lectures at various institutions and conferences: • May 21, 2020 - Shaiba Sandhu, PGY2, presented in the Oral Medicine Centralized Grand Rounds organized by the American Academy of Oral Medicine (AAOM). • September 30, 2020 - Dr. Nathaniel Treister, Dr. Sandhu and Rossella Intini, PGY3, presented in the Wide World of Oral Medicine Through the Resident Perspective webinar organized by the AAOM. • May 20, 2021 - Dr. Intini presented in the Oral Medicine Centralized Grand Rounds organized by the AAOM. • May of 2021 - Amal Bajonaid, PGY-3, received an award from the AAOM Research Advancement Committee (RAC) for her project titled, “An Evaluation of Oral Medicine Education in Predoctoral Dental Programs and Its Relation to the Students’ Perception of Oral Medicine.” At the annual faculty retreat in June of 2021, the faculty discussed preparations for the next Commission on Dental Accreditation (CODA) site visit in 2023. Other retreat topics included the evaluation of residents, their clinical service rotations, the objectives and evaluations of off-site rotations, how to maximize effectiveness of the virtual interview process and how to optimize the education fund for residents’ well-being. E. CURRENT CHALLENGES There is always more work to be done to support the health of the community. The growing patient base puts a strain on our allotted resources, with physical space being a top priority. A larger space would allow the division to conduct more clinical sessions and see more patients each week. The division would also like to increase the number of GME resident positions from four to six. In the last year we’ve submitted a new initiative request for the expansion, which we hope to have approved by the Brigham in the spring of 2022. 70

F. VISION AND FUTURE OPPORTUNITIES The Division of Oral Medicine and Dentistry is guided by the principle that prevention, diagnosis, management and treatment of oral diseases is essential to advancing oral health and fundamental to optimizing treatment outcomes. We are committed to being the preeminent center for collaborative oral medicine care, education, discovery and innovation. The division is pursuing a plan to add additional space and expand our clinical services geographically. We are currently working with the hospital on a plan to open clinics in Weymouth, Foxborough and/or Brigham and Women’s Faulkner Hospital. Additionally, the division sees an opportunity to expand our clinical footprint at DFCI and Boston Children’s in the future. 71

Otolaryngology – Head and Neck Surgery A. OVERVIEW After years of being part of the Brigham/Beth Israel Deaconess Medical Center (BIDMC) Joint Center for Otolaryngology, the Brigham Division of Otolaryngology was founded in 1999, with Jo Shapiro, MD, serving as chief. Dr. Shapiro stepped down in March 2016, but under her leadership the division grew from five attending physicians to eight, and the clinic was moved to its current location on the Brigham main campus. Ravindra Uppaluri, MD, PhD, was named division chief in 2017 and has focused on growing the division programmatically within otolaryngology subspecialties. The division now includes 15 faculty members and is recognized nationally for our clinical and academic efforts in head and neck cancer, laryngology, rhinology, otology and sleep medicine. In addition, the division has a national reputation in cutting-edge research, which ranges from basic and translational research in head and neck cancer, to health outcomes research in patient care and disparities. The division has continued to recruit health professionals to support the growing audiology and speech, voice and swallowing clinical programs. Additionally, the division has expanded its footprint to provide services at Brigham and Women’s Faulkner Hospital (BWFH) and in Foxborough. Perhaps most notably, the division’s ranking in the U.S. News and World Report survey of Ear, Nose and Throat programs rose from “unranked” three years ago to within the top 20 in the nation in 2021. B. CLINICAL SERVICES Areas of excellence in the division include head and neck cancer, voice/swallowing, rhinology, otology and sleep medicine. A major focus since 2017 has been to expand services in each of the otolaryngology subspecialties. • We have recruited two additional head and neck surgeons, two laryngologists and two rhinologists, including a new section leader. These six surgeons are all fellowship trained in their specialty areas. • For the voice and swallowing program, we have appointed a director of Voice Pathology and recently hired an additional speech-language pathologist. • We have expanded our advanced practitioner practice (APP) with the addition of two nurse practitioners to bring this complement to three providers, practicing at each one of our clinical locations: BWH main campus, BWFH, Foxboro and Dana-Farber Cancer Institute (DFCI). The division’s head and neck surgeons are key players in the internationally recognized Head and Neck Oncology program at Dana-Farber/Brigham and Women's Cancer Center, offering multidisciplinary 72

patient management for complex oncologic conditions. In addition to offering state-of-the-art reconstructive approaches, we are also leaders in transoral robotic surgery with minimally invasive tumor removal. Our surgeons have played key roles in the Brigham Face Transplant Program with Donald Annino, MD, DMD, who served as the head and neck surgeon leader for the first face transplant in the New England region. We have developed and participated in multiple novel clinical trial approaches to improve outcomes for patients with diverse head and neck malignancies. We have examined our outcomes in Virtual Surgical Planning (VSP) for mandibular reconstructions — one of the largest series in this area — and will be presenting this data at an upcoming national meeting. Our Voice Program and laryngology section, led by Thomas Carroll, MD, is recognized regionally and nationally for their multidisciplinary approach. All patients are seen simultaneously by a laryngologist and speech-language pathologist (SLP) at the initial visit, creating a seamless, efficient and comprehensive patient experience. C. Eduardo Corrales, MD, offers the full spectrum of care in otology/neurotology, including chronic ear disease, complex vestibular entities and lateral skull base tumor management (in collaboration with our colleagues in neurosurgery). Our audiology program focuses on hearing rehabilitation, including collaborating with Dr. Corrales on a recently established cochlear implant program. We are actively expanding the rhinology program and working with colleagues in Allergy/Immunology to develop a state-of-the-art Sinus Center. This group provides care for patients with inflammatory, neoplastic and skull base disorders, including chronic rhinosinusitis, cystic fibrosis and sinonasal neoplasms. The rhinology group also collaborates with Brigham neurosurgeons, performing complex endoscopic skull base surgeries in a team-based manner. Stella Lee, MD was recently recruited to lead and grow the section. Dr. Lee is a national leader in the field, with experience spearheading clinical trials, developing cystic fibrosis centers, creating HHT centers of excellence, and bringing bench research to patients through cutting-edge therapies. We also work in collaboration with the Division of Sleep Medicine in the multidisciplinary management of patients with obstructive sleep apnea. Led by Anthony Prince, MD, we have developed a successful and growing sleep surgery program, including the hypoglossal nerve stimulator implant program. 73

C. RESEARCH ACTIVITIES Head and Neck Cancer Clinical Trials Listed below are surgery-based trials that division surgeons participate in or lead. Please note, there are multiple non-surgical trials where our surgeons play key roles that are not listed below. 1. Neoadjuvant clinical trials - The Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) Head and Neck Oncology Program is a national leader in trials, including neoadjuvant immunotherapy prior to surgery. Listed below are four trials (three completed and published or in press, and one ongoing Phase 3 trial with this concept). a. Immunotherapy with MK-3475 in locoregionally advanced, surgically resectable head and neck squamous cell carcinoma (Uppaluri, PI). b. Adjuvant nivolumab and lirilumab in patients with relapsed, resectable squamous cell carcinoma of the head and neck (Hanna, PI). c. Window study of nivolumab with or without ipilimumab in squamous cell carcinoma of the oral cavity (Schoenfeld, PI). d. Study of pembrolizumab given prior to surgery and in combination with radiotherapy given post-surgery for advanced head and neck squamous cell carcinoma (MK-3475- 689). This is a Phase 3 international study and Dr. Uppaluri is on the steering committee. 2. Human papillomavirus head and neck cancer trials a. Defining post-treatment surveillance in HPV+ oropharyngeal cancer with circulating tumor HPV DNA (E. Rettig, Co-PI) b. A phase 2 study of de-intensified risk-ADAPTed postoperative radiation therapy for human papillomavirus associated oropharyngeal squamous cell carcinoma: The “ADAPT” Trial (E. Rettig- Co-PI) c. IDEA-HPV- improving detection and early action for HPV-positive oropharynx cancer (E. Rettig, PI) Basic and Translational Research Dr. Uppaluri leads an NIH-funded laboratory focused on understanding response and resistance mechanisms to immunotherapy in head and neck cancers. Funding is listed in the “Key Grants” section. Health Services Research • Jennifer Shin, MD, SM, is an internationally recognized leader in patient-reported outcomes and evidence-based medicine in otolaryngology. She is the deputy editor of Otolaryngology-Head and Neck Surgery—the flagship journal of the American Academy of Otolaryngology-Head and Neck Surgery • Eleni Rettig, MD, is focused on HPV-related head and neck cancers and approaches for non- invasive monitoring and surgical de-intensification strategies. 74

• Regan Bergmark, MD, conducts disparities-related research and in particular is focused on improving access to surgical care. • Rosh Sethi, MD, MPH, conducts research on health outcomes and cost transparency in the context of head and neck surgery. • Thomas Carrol, MD, is focused on the development of novel injectables for laryngeal issues and associated outcomes. • Rachel Roditi, MD, collaborates with colleagues in Allergy/Immunology in several clinical trials. • C. Eduardo Corrales, MD, is working with colleagues in Radiology to develop augmented reality technology to improve skull base surgery. • Laura Goguen, MD, and Donald Annino, MD, DMD, are analyzing clinical outcomes in patients who undergo complex mandibular reconstruction. • Laura Goguen, MD and Rosh Sethi, MD, MPH, have worked with Dana-Farber to create the first EPIC-integrated, patient-reported outcome measuring tool for head and neck cancer patients. Key Grants Name of study: Disparities in Timely Access to Quality Surgical Care at Brigham Health and in the Boston Community PI(s): Regan Bergmark, MD Funding source: Brigham and Women’s Hospital H. Richard Nesson Fellowship Funding amount: $180,000 (2021-2023) Brief description of the study w/goals and objectives: The goal of this proposal is to complete a mixed- methods examination of disparities in timely access to surgical care at Brigham Health and the greater Boston community through analysis of institutional data and interviews with patients who have presented in a delayed fashion. Objectives: 1) To assess the association of patient characteristics with delayed presentation for surgical conditions at Mass General Brigham; and 2) to describe the care pathways for patients with delayed presentations of surgical conditions at Mass General Brigham and surrounding health care systems, and identify barriers to earlier presentation. Name of study: Immunotherapeutic Responses to Neoantigens in Head and Neck Cancer PI(s): Ravi Uppaluri, MD, PhD, with co-investigator S. Elledge Funding source: NIH/National Institute of Dental and Craniofacial Research Funding amount: $1,750,000 (2018-2023) Brief description of the study w/goals and objectives: The aim of this study is to define neoantigen specific responses in head and neck cancers. Name of study: Defining Immunotherapy Resistance Mechanisms in Head and Neck Cancer PI(s): Ravi Uppaluri, MD, PhD communicating PI, with co-PIs D. Barbie and R. Haddad Funding source: NIH/NCI/National Institute of Dental and Craniofacial Research Funding amount: $3,093,521 (2019-2024) Brief description of the study w/goals and objectives: The aim of this study is to identify head and neck cancer-related immunotherapy resistance mechanisms. 75

Name of study: Immunogenomic Approaches in Anti-PD1 Treated Head and Neck Cancers PI(s): Ravi Uppaluri, MD, PhD Funding source: V Foundation Translational Research Award Funding amount: $600,000 (2015-present) Brief description of the study w/goals and objectives This project seeks to define immunogenomic parameters of response to checkpoint blockade in a clinical trial of head and neck cancer patients treated with neoadjuvant anti-PD1. Name of study: Genomic Insights and Therapeutic Targeting of Oral Cancer Tumor Initiating Cells PI(s): Ravi Uppaluri, MD, PhD Funding source: NIH/National Institute of Dental and Craniofacial Research Funding amount: $1,000,000 (2014-2020) Brief description of the study w/goals and objectives This project seeks to genomically characterize tumor heterogeneity and define molecules associated with oral cancer aggressiveness. Exemplary Publications R. Uppaluri et al. Neoadjuvant and Adjuvant Pembrolizumab in Resectable Locally Advanced, Human Papillomavirus-Unrelated Head and Neck Cancer: A Multicenter, Phase 2 Trial. Clinical Cancer Research. October 2020. Bergmark RW, Palumbo M, Rahman S, Maurer R, Dominas C, Roditi R, Bhattacharyya, N, Maxfield AZ, Buchheit KM, Laidlaw TM. Aspirin-Exacerbated Respiratory Disease: Association Between Patient Reported Sinus and Asthma Morbidity. J Allergy Clin Immunol Pract. 2020. Prince A, Bhattacharyya, N. An Analysis of Adverse Event Reporting in Balloon Sinus Procedures. Otolaryngology Head Neck Surg. 2016. Carroll TL, Werner A, Nahekian K et al. Rethinking the Laryngopharyngeal Reflux Treatment Algorithm: Evaluating an Alternate Empiric Dosing Regimen and Considering Up-Front, pH-Impedance, and Manometry Testing to Minimize Cost in Treating Suspect Laryngopharyngeal Reflux Disease. The Laryngoscope. 2017. Gadkaree SK, Weitzman RE, Yu PK, Miller AL, Ren Y, Corrales CE. The Role of Body Mass Index on Hearing Outcomes After Stapes Surgery. Otology Neurotology. 2019. 76

D. EDUCATIONAL ACTIVITIES Rachel E. Roditi, MD, leads the division’s HMS medical student education and Alice Maxfield, MD, is the site director and associate program director for the Harvard Combined Otolaryngology Residency. The medical student experience consists of clinic/OR elective and advanced rotations along with lectures (with residents). Dr. Roditi also directs the otolaryngology portion of the Practice of Medicine Course, an annual course for students in the Pathways program at Harvard Medical School. For the residency, each rotation is a 10-week period during which a cohort of five residents representing PGY-1 through PGY-5 participate in the clinical management of our patients. This is a busy clinical rotation as residents experience graduated responsibility in the OR for the full spectrum of otolaryngology, coupled with outpatient experience in the clinics. This experience is augmented with a lecture series that complements the ongoing didactic sessions at the Massachusetts Eye and Ear Hospital. It is important to note that since July 2021, the residency transitioned this rotation from a BIDMC/Brigham experience to a full-time Brigham-only rotation and thus Brigham training represents 20% of the resident training experience. To maximize their experience and focus on their wellness, Dr. Maxfield revamped our Brigham educational conference and rotation for the residents. The faculty also provides research mentoring for residents and students through their FOCUS projects and HMS scholarly projects. As a testament to our commitment to resident education, Dr. Annino (2019) and Dr. Corrales (2020), were selected by the residents as “Teachers of the Year” across the entire four- hospital Harvard faculty. Finally, our physician assistant, Julie Richards, was selected for the 2021 Resident Life Award. E. CURRENT CHALLENGES There are external and internal challenges that impact full realization of the division’s potential. We practice in a city with several outstanding hospitals, and this clinical competition impacts growth. The faculty in our group are also impacted by the ongoing changes at Mass General Brigham and how otolaryngology will ultimately be conceived as a unified clinical operation. Internally, there are obstacles at the Brigham and within our own division. A major ongoing issue is in the smooth operation of the operating rooms, which is in part related to staffing at the hospital level. Internal to the division, these staffing challenges – difficulty in hiring and retaining staff – also impact our clinical operation with respect to new patient access and established patient care. The widely documented impact of the electronic medical record on physician wellness (including working off hours to complete charting/orders) is a significant driver of burnout. Together, these challenges increase the productivity and financial pressures felt by the faculty, which in turn can have a negative effect on academic productivity. This can lead to some job dissatisfaction for faculty members who are committed to the academic aspects of the job. 77

F. VISION AND FUTURE OPPORTUNITIES Our vision is to build an otolaryngology practice that is focused on providing outstanding clinical services, while studying our patients and clinical outcomes and performing cutting-edge basic and translational research to advance the field. Patients in our practice present with some of the most complex otolaryngologic pathologies, including those in head and neck cancer, rhinology, laryngology and otology/neurotology. We strive to provide advanced clinical care to achieve the best patient outcomes and explore new approaches to improve quality of life. These goals are balanced by our focus on faculty development and our teaching mission to train the next generation of otolaryngologists. We aspire to supporting and developing the careers of faculty who represent the future leaders in our field. 78

Plastic and Reconstructive Surgery A. OVERVIEW The Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital provides innovative and groundbreaking comprehensive plastic surgical care. The mission of the division is threefold: • To provide the highest quality plastic surgical care to patients in need • To advance the science of plastic surgery through research • To provide an unsurpassed level of education for trainees in plastic surgery The Division of Plastic Surgery was established at Brigham and Women’s Hospital, formerly the Peter Bent Brigham Hospital, by Joseph E. Murray, MD, in 1949. In addition to pioneering kidney transplantation, research and clinical advances, Dr. Murray also introduced craniofacial surgery and in 1966 performed the first midfacial advancement procedure in the United States. Andrea L. Pusic, MD, MHS, FACS, FRCSC, joined the division as chief in 2018. She is the Joseph E. Murray Professor of Surgery at Harvard Medical School and director of the Patient-Reported Outcomes, Value & Experience (PROVE) Center at Mass General Brigham. Under her leadership, the division continues to be at the forefront of plastic surgery care. Clinical excellence, research innovation and an emphasis on patient-reported outcomes are improving care for patients seeking reconstructive or aesthetic surgery. Our team of specialists has the expertise to address the most complex challenges, including reconstruction surgery for cancer, microsurgical extremity reconstruction, vascularized composite allotransplantation (VCA) for hand and lower extremity transplantation, nerve regeneration and gender-affirming surgery. B. CLINICAL SERVICES The Division of Plastic and Reconstructive Surgery offers comprehensive reconstructive and aesthetic plastic surgery services that improve patient-centered outcomes and quality of life. The division excels in cancer reconstruction, with a focus on microsurgery, as well as extremity reconstruction for hand, upper and lower extremity, and trauma reconstruction. Breast reconstruction is one of our highest volume clinical services. The program requires close collaboration with the Division of Breast Surgery. This most recent fiscal year, the volume of total immediate reconstruction cases is on pace to increase nearly 20% over the average of the prior three years, and the volume of immediate autologous flap reconstruction is on pace to increase roughly 60%. Additionally, our surgeons now offer expanded reconstruction options, including oncoplastic surgery and advanced microsurgical procedures to treat and prevent breast cancer-associated lymphedema. 79

The division has also been at the forefront of upper and lower extremity reconstruction. We have developed a close working relationship with the Department of Orthopedic Surgery, optimizing outcomes for both orthopedic trauma and oncology patients and utilizing the latest advancements in microsurgery and peripheral nerve surgery. Additionally, in conjunction with Orthopedic Surgery, we have initiated an osseointegration program. This collaboration has extended to Spaulding Rehabilitation Hospital, with the start of the Mass General Brigham Amputee Fellowship. Significant advancements in upper and lower extremity amputation have also been made within our division, including the Ewing amputation. Under the leadership of a new director of Craniofacial Surgery, we have recently developed a new program to provide care for adult patients with craniofacial anomalies. We are also collaborating closely with the Department of Neurosurgery to optimize functional and aesthetic outcomes for patients undergoing tumor resection. C. RESEARCH ACTIVITIES A significant portion of the division’s research activities are focused on expanding how to measure and improve outcomes from the patients’ perspective. Through the PROVE center, patient-reported outcome (PRO) measurement has been expanded across the division to bring patient-centered data to the forefront of clinical decision-making. Our aim is to optimize the patient’s quality of life, including physical function, symptoms and body image, across the whole spectrum of plastic surgery. As an example of this focus, the imPROVE breast cancer care app was designed by our team to collect PROs in routine care for all breast cancer patients and provide immediate feedback and links to tailored resources and support. In addition, our team has a robust collaboration with the Harvard Business School related to PROs and the determination of health care value. Several of our faculty lead major translational and clinical research programs. Ongoing work in novel amputation techniques, including the Ewing amputation, have received significant grant support and continue to change lives. Our composite allotransplantation (VCA) program also continues to make progress in the areas of upper and lower extremity transplantation. Additionally, our investigators pursue various studies that align with their clinical interests, such as breast reconstruction. The division also has a robust basic science program which focuses on developing novel treatments for patients with limited therapeutic options. This research focuses primarily on tissue regeneration, including recovery from traumatic soft tissue and bone injuries, wounds and burns. For such injuries, we have developed and investigated pharmacotherapies, tissue engineering strategies and gene editing techniques. 80

Within the last five years, we have received grants from the Department of Defense and industry support to continue our research, and have received patents for our inventions. Key Grants Name of study: Scaling and Spreading the Electronic Capture of Patient-Reported Outcomes Using a National Surgical Quality Improvement Program PI(s): Andrea Pusic, MD (co-PI) Funding source: Agency for Healthcare Research and Quality (AHRQ) Funding amount: $1,500,000 Brief description of the study w/goals and objectives: Incorporating the patient’s perspective to evaluate surgical quality has yet to be achieved in the U.S. and represents a tremendous unrealized opportunity for continuous quality improvement. The study aims to scale and spread the routine, IT- enabled collection of PROs from ambulatory surgical patients using a well-established national surgical quality improvement registry program. Name of study: A Novel Approach to Lower Extremity Amputation to Augment Volitional Motor Control and Restore Proprioception PI(s): Matthew Carty, MD Funding source: Department of Defense Funding amount: $2,803,902 Brief description of the study w/goals and objectives: This clinical trial will evaluate a fundamentally new surgical approach to lower extremity amputation, with the goal of providing significantly improved voluntary motor control and restored sense of position (proprioception) in the residual limb. Name of study: A Novel Approach to Upper Extremity Amputation to Augment Volitional Motor Control and Restore Proprioception PI(s): Matthew Carty, MD Funding source: Department of Defense Funding amount: $2,991,750 Brief description of the study w/goals and objectives: This clinical trial will evaluate a fundamentally new surgical approach to upper extremity amputation, with the goal of providing significantly improved voluntary motor control and restored sense of position (proprioception) in the residual limb. Name of study: Aging-Associated Dysregulation of the Hypoxia Pathway Limits Skeletal Muscle Regeneration PI(s): Indranil Sinha, MD Funding source: National Institutes of Health Funding amount: $1,209,880 Brief description of the study w/goals and objectives: Aging results in a severe decline of skeletal muscle regenerative potential. Interestingly, this loss of muscle regeneration can potentially be reversed by restoring growth factors and signals, which become lost in normal muscle aging. This grant evaluates 81

whether pharmacotherapies focused on aryl hydrocarbon receptor nuclear translocator, a central component of hypoxia signaling which declines precipitously in aging, is sufficient to rejuvenate and maintain muscle function with aging. Name of study: Extremity Regeneration of Soft Tissue Injury Using Growth Factor-Impregnated Gels PI(s): Simon Talbot, MD Funding source: U.S. Army Medical Research Acquisition Activity Funding amount: $2,100,000 Brief description of the study w/goals and objectives Severe extremity trauma presents a high risk for amputation because of ischemia and avulsion injuries to soft tissues, muscle and nerve. While promising tissue engineering approaches under development are far from clinical application, this project proposes a near-term solution based on promoting regeneration of host tissue, rather than creating new, engineered tissue constructs. Exemplary Publications Pusic AL, Temple LK, Carter J, Stabile CM, Assel MJ, Vickers AJ, Niehaus K, Ancker JS, McCready T, Stetson PD, Simon BA. A Randomized Controlled Trial Evaluating Electronic Outpatient Symptom Monitoring after Ambulatory Cancer Surgery. Ann Surg. 2021 Sep 1;274(3):441-448. PM ID: 34132697 Ortega G, Allar BG, Kaur MN, Edelen MO, Witt EE, Fayanju OM, Telem DA, Wagman LD, Sisodia RC, Powe NR, Pusic AL. Prioritizing Health Equity in Patient-Reported Outcome Measurement to Improve Surgical Care. Ann Surg. Published online August 13, 2021. PMID: 34387209. Herr HM, Clites TR, Srinivasan SS, Talbot SG, Dumanian GA, Cederna PS, Carty MJ. Reinventing Amputation in the Era of Functional Limb Restoration. Ann Surg. 2021 Feb 1;273(2):269-279. PMID: 32324689 Beederman M, Garza RM, Agarwal S, Chang DW. Outcomes for Physiologic Microsurgical Treatment of Secondary Lymphedema Involving the Extremity. Ann Surg. Published online September 1, 2020. Sep 1. PMID: 32889875 Endo Y, Zhang Y, Olumi S, Karvar M, Agarwal S, Neppl R, Sinha I. Exercise Induced Gene Expression in Skeletal Muscle of Old Mice. Genomics. 2021 Sep;113(5):2965-2976. PMID: 34214629 D. EDUCATIONAL ACTIVITIES In the last five years, the division has established two new clinical fellowships: hand surgery fellowship in collaboration with the Department of Orthopedic Surgery and a microvascular reconstructive breast surgery fellowship (refer to Appendix 3 for more information about the latter). These new training programs align with the division’s clinical focus and serve our mission of training the next generation. 82

E. CURRENT CHALLENGES The division is well-positioned to continue its success in clinical care, research and education; however, in the near-term, challenges with efficiencies in the operating rooms are a concern for continued clinical growth. To perform optimally in an academic setting, we depend on faculty to use their dedicated clinical time at maximum capacity. When operational issues impede their ability to complete cases efficiently, surgeons are left with less time to deliver on their academic and personal obligations, or they sacrifice patient volume. We hope to actively partner with hospital leadership to address root causes and allow faculty to use their OR time optimally. F. VISION AND FUTURE OPPORTUNITIES Building on established clinical strengths in oncologic and extremity reconstruction and our research expertise in tissue regeneration, the division will continue to expand the limits of what is possible in the field of plastic surgery. We will also continue to increase the collection and use of PRO data to guide clinical care, quality improvement and innovation. Additionally, the division plans to establish itself as a leader in the field of transgender health. Under the leadership of a recently hired, prominent plastic surgeon, Devin O’Brien-Coon, MD, who specializes in gender-affirming surgery, the emerging Center for Transgender Health (CTH) will provide comprehensive clinical services to transgender patients. The CTH will unite staff and faculty within the Brigham and Mass General Brigham to advance research, education and advocacy for this patient group. Finally, an important future focus will be faculty fulfillment. We recognize the importance of creating flexibility to allow individuals to create the practices in which they are the most fulfilled and best able to balance professional and personal priorities. 83

Surgical Oncology A. OVERVIEW The Division of Surgical Oncology at Brigham and Women’s Hospital provides comprehensive evaluation, diagnosis, treatment and management of adult patients with general surgical and oncologic problems. Division surgeons see patients in the ambulatory and inpatient setting at both the Brigham and Dana- Farber Cancer Institute (DFCI). Surgeons within the division specialize in the treatment of: • benign and malignant endocrine disorders • malignancies of the gastrointestinal (GI) tract including colorectal, hepatic, biliary, pancreatic, and neuroendocrine neoplasms • melanoma and other cutaneous malignancies • soft tissue sarcomas Heritage The Division of Surgical Oncology was founded in 1975, when Richard E. Wilson, MD – a pioneer in the field of solid tumor oncology and cancer clinical research – was appointed chief of Surgical Oncology at both the Brigham and DFCI. In 2007, Monica M. Bertagnolli, MD, a translational researcher focusing on gastrointestinal cancer biology, became the fourth chief of Surgical Oncology. Dr. Bertagnolli stepped down from her division leadership role in 2018 to focus on her national roles as group chair for the Alliance for Clinical Trials in Oncology and as president of the American Society of Clinical Oncology. In 2019, after a national search, Chandrajit P. Raut, MD, MSc, a clinical trialist and translational researcher specializing in soft tissue sarcoma, was appointed as the fifth chief of the division. In 1996, the Brigham joined DFCI and Massachusetts General Hospital (MGH) in a joint venture in adult oncology titled Dana-Farber/Partners Cancer Care. The Brigham joined with DFCI in 2006 to form the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC, recently renamed as Dana- Farber/Brigham Cancer Center or DF-BCC), a partnership to provide seamless adult cancer clinical services. To foster basic and clinical cancer research, the Brigham joined with HMS, the Harvard School of Public Health and other Harvard affiliates to form the Dana-Farber/Harvard Cancer Center (DF/HCC), a comprehensive cancer center funded by the National Cancer Institute in 1999. These multilayered relationships offer division faculty unparalleled opportunities to interact with colleagues of all disciplines, sharing state-of-the-art resources and participating fully in Harvard’s rich intellectual environment. 84

Current Division Faculty The Division of Surgical Oncology made structural changes when Dr. Bertagnolli stepped down as chief of the division in 2018. The Breast Surgery faculty were separated into their own division and the Division of Surgical Oncology was expanded to include the Endocrine Surgery section and its faculty members from the General Surgery division. Endocrine surgeon Francis J. Moore, Jr., MD, who stepped down as chief of the Division of General and Gastrointestinal Surgery and who also served as vice chair of the Department of Surgery, departed the Brigham in 2019. Leadership • Nancy L. Cho, MD – Section Chief, Endocrine Surgery • Thomas E. Clancy, MD – Director, Minimally Invasive Pancreatic Surgery; Associate Director, Pancreatic Surgery • Gerard Doherty, MD – Chair, Department of Surgery • Mark Fairweather, MD – Program Director, Mass General Brigham/Dana-Farber Complex General Surgical Oncology Fellowship at Harvard Medical School • Matthew A. Nehs, MD – Program Director, Harvard Combined Endocrine Surgery Fellowship • Chandrajit P. Raut, MD, MSc – Chief, Division of Surgical Oncology • Jiping Wang, MD, MS, PhD – Director, Minimally Invasive Gastric Surgery; Associate Director, Hepatobiliary Surgery • Charles H. Yoon, MD, PhD – Surgical Director, DF-BCC Melanoma and Cutaneous Oncology Programs B. CLINICAL SERVICES Division specialists participate in multidisciplinary care of cancer patients through affiliation with disease center programs at DFCI; they also care for patients with endocrine disorders at the Brigham. Clinical Programs DF-BCC (Brigham Cancer Center) Gastrointestinal Cancer Center The Gastrointestinal Cancer Center, a program of DF-BCC, provides comprehensive evaluation, treatment and management of patients with gastrointestinal malignancies. The center is jointly staffed and operated by Brigham departments of Surgery, Radiology, Radiation Therapy and Pathology; and DFCI services in medical oncology, cancer epidemiology and control, and human cancer genetics. Active division participants in DF/BWCC GI Cancer Center clinical programs and clinical research include Drs. Clancy, Fairweather, Molina and Wang. 85

DF-BCC Melanoma and Cutaneous Oncology Programs Multidisciplinary management of patients with cutaneous malignancies, including melanomas, non- melanoma skin cancers and cutaneous lymphomas, is coordinated through members of the DF-BCC Melanoma and Cutaneous Oncology Programs (two individual programs). Dr. Yoon is the surgical director of these programs. Division members are active contributors to clinical trials originating from this program. In addition, Dr. Yoon collaborates with program colleagues in medical oncology (R. Steven Hodi, MD, and Thomas Kupper, MD) to conduct studies of basic melanoma tumor biology and pre- clinical drug testing. Active division participants include Dr. Cho. DF-BCC Center for Sarcoma and Bone Oncology This center is among the nation’s largest for the treatment of soft tissue sarcoma and represents one of the most active centers for sarcoma clinical and translational research. A multidisciplinary approach involving pathology, oncologic and reconstructive surgery, radiotherapy, chemotherapy and novel drug development has resulted in improved outcomes for sarcoma patients over the past two decades. In particular, work conducted by center faculty over the past two decades has evaluated the efficacy of targeted therapy and surgery for primary and advanced gastrointestinal stromal sarcomas and radiation therapy, plus surgery for retroperitoneal sarcomas. Active division participants include Drs. Bertagnolli, Fairweather, Raut and Wang. Endocrine Surgery The endocrine surgery program offers a multidisciplinary approach to the care of benign and malignant diseases of the thyroid, parathyroid and adrenal glands. The division offers the only program in retroperitoneoscopic surgery for adrenal tumors in the U.S. Active division participants include Drs. Cho, Doherty and Nehs. C. RESEARCH ACTIVITIES Research interests of the faculty in the Division of Surgical Oncology are varied, and include work in the areas of new treatments, quality-of-life, biomarker development, cancer biology and cancer genetics. • Dr. Bertagnolli has a longstanding interest in the biology of colorectal cancer, and previously directed an NCI-funded basic research laboratory that studied genotype-phenotype relationships for the APC tumor suppressor gene. She has also utilized large clinical trial cohorts to conduct significant work in the field of colorectal cancer biomarker development. Dr. Bertagnolli currently holds a major administrative role in cancer research as the group chair of the Alliance for Clinical Trials in Oncology, an NCI-funded cancer cooperative group. • Dr. Raut has an extensive publication record detailing both single institution and multicenter clinical outcomes for patients treated for soft tissue sarcomas. He has been co-PI and co- investigator on several U.S.-based multi-institutional and international clinical trials in sarcoma. He was PI of an NIH R01 together with Yolanda L. Colson, MD, PhD, chief of Thoracic Surgery at Massachusetts General Hospital, and Mark W. Grinstaff, PhD, director of the Nanotechnology Innovation Center at Boston University. They are working together to develop novel platforms 86

for local delivery of chemotherapy agents as an adjunct to cancer surgery. He also co-founded the Transatlantic Australasian Retroperitoneal Sarcoma Working Group, a research collaborative including more than 160 sarcoma centers from 45 countries across five continents. • Dr. Yoon has funding as co-PI on several grants to study melanoma tumor biology. He has developed important new resources for therapeutic drug testing, including full characterization of many melanoma cell lines. • Dr. Wang holds a PhD in biostatistics and is currently engaged in NCI-funded research in cancer genomics, including design and analysis of genome-wide association studies within randomized cancer prevention and treatment trials. • Dr. Nehs has held external funding evaluating the role of glycolytic inhibition in the growth of anaplastic thyroid cancer. • Dr. Cho previously held external funding focused on the study of desmoid tumors. Her current research is evaluating disparities involving women surgeons. • Dr. Gawande’s research focuses on health systems innovation. • Dr. Molina joined the division in 2020 and has already been awarded several grants in pursuit of a career in health services research. Finally, a number of division members, including Dr. Clancy and Dr. Fairweather, are actively involved in clinical research, either by study of retrospective case cohorts or by participation in cancer clinical trials. The division is also home to a brilliant clinical trial methodologist, Steven Piantadosi, MD, PhD, an associate senior biostatistician in the division. Research Programs Alliance for Clinical Trials in Oncology (Alliance) Chaired by Monica M. Bertagnolli, MD, the Alliance seeks to reduce the impact of cancer by uniting a broad community of scientists and clinicians who are committed to discovering, validating and disseminating effective strategies for the prevention and treatment of cancer. The Alliance is comprised of nearly 10,000 cancer specialists at across the United States and Canada. The Alliance for Clinical Trials in Oncology develops and conducts clinical trials with promising new cancer therapies, and utilizes the best science to develop optimal treatment and prevention strategies, as well as research methods to alleviate side effects of cancer and its treatments. The Alliance is part of the National Clinical Trials Network (NCTN) sponsored by the National Cancer Institute (NCI) and serves as a research base for the NCI Community Oncology Research Program (NCORP). NCI-Specialized Programs in Research Excellence (SPORE) Awards These awards serve as an important focus for translational research at the Dana-Farber/Harvard Comprehensive Cancer Center (DF/HCC). The DF-BCC GI Cancer Center was awarded a SPORE in Gastrointestinal Cancer in 2007. Dr. Bertagnolli served as a co-PI of this award from 2007 to 2010, when she stepped down to devote more time to the Alliance. Division members, particularly Dr. Clancy, remain active participants in this research program. Dr. Yoon, a melanoma surgeon and researcher, is 87

also an active member of the research team associated with the DF-BCC Skin SPORE, led by Dr. Thomas Kupper. Center for Surgery and Public Health The Center for Surgery and Public Health (CSPH), a collaboration between the Brigham and the Harvard School of Public Health, was established in 2005 to advance the science of surgical care delivery by studying effectiveness, quality, equity and value at the population level; improving surgical education; and developing surgeon-scientists committed to excellence in these areas. Oncopanel In 2012, DFCI and the Brigham launched Profile (now renamed Oncopanel), a major effort to scan tumor tissue from adult cancer patients for hundreds of gene mutations linked to cancer. The program, nearly two years in development, is one of the most extensive research projects in cancer genomics yet undertaken nationally. Open to every adult cancer patient seen in DF/BWCC facilities, the program is building a comprehensive database for research into the genetic makeup of different cancer types and, ultimately, into treatments that are most effective against individual tumors. Dr. Bertagnolli served on the scientific steering committee of this program, and all division members offer participation in this program to each patient scheduled for surgery at the Brigham. Key Grants Name of study: Alliance for Clinical Trials in Oncology Network Operations Group PI: Monica Bertagnolli, MD Funding source: National Cancer Institute (U10CA180821) Funding amount: $106,500,000 Brief description of the study w/goals and objectives: The Alliance is an experienced multi-institutional cancer clinical trials group. The mission of the organization is to reduce the impact of cancers by 1) conducting high-quality multidisciplinary cancer control, prevention, and treatment trials that engage a comprehensive research network; 2) furthering the understanding of the biological basis of cancer and its treatments; and 3) providing an infrastructure for innovative clinical and translational research. Name of study: Targeting Hyaluronic Acid in Desmoid Tumors PI: Nancy Cho, MD Funding source: Desmoid Tumor Research Foundation Grant Funding amount: $90,000 Brief description of the study w/goals and objectives: The goal of this project is to study the role of hyaluronic acid in contributing to desmoid tumorigenesis 88

Name of study: Efficacy and Safety of a Novel, Implantable Drug-Eluting Film in Sarcoma PI: Chandrajit Raut, MD Funding source: National Institutes of Health, R01-EB017722-01A1 Funding amount: $1,100,000 Brief description of the study w/goals and objectives: The aims of this study are to evaluate the efficacy and safety of paclitaxel-loaded biodegradable films in in vitro organotypic cultures from human sarcoma tumor samples, in in vivo mouse xenografts, and large animals undergoing surgery. Name of study: Genomic comparison between very young (<=35 years old) and older gastric cancer patients (>=70 years old) PI: Jiping Wang, MD, PhD Funding source: Trustbridge Funding amount: $250,000 Brief description of the study w/goals and objectives: This study focuses on genomic comparison between very young (<=35 years old) and older gastric cancer patients (>=70 years old). Exemplary Publications Gronchi A, Strauss DC, Miceli R, Bonvalot S, Swallow CJ, Hohenberger P, van Coevorden F, Rutkowski P, Callegaro D, Hayes AJ, Honore C, Fairweather M, Cannell A, Jakob J, Haas RL, Szacht M, Fiore M, Casali PG, Pollock RE, Raut CP. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma: a report of 1,007 patients from the multi-institutional collaborative Transatlantic RPS Working Group. Ann Surg 2016;263(5):1002-9. PMID: 26727100. Semrau KEA, Hirschhorn LR, Marx Delaney M, Singh VP, Saurastri R, Sharma N, Tuller DE, Firestone R, Lipsitz S, Dhingra-Kumar N, Kodkany BS, Kumar V, Gawande AA. Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India. N Engl J Med. 2017 12 14; 377(24):2313-2324. PMID: 29236628. Raut CP, Espat NJ, Maki RG, Araujo DM, Trent J, Williams TF, Purkayastha DD, DeMatteo RP. Five-year adjuvant imatinib for patients with intermediate/high-risk primary gastrointestinal stromal tumor: the phase 2, multi-institutional PERSIST-5 clinical trial. JAMA Oncol 2018 Dec 1;4(12):e184060. PMID: 30383140. Jerby-Arnon L, Shah P, Cuoco MS, Rodman C, Su MJ, Melms JC, Leeson R, Kanodia A, Mei S, Lin JR, Wang S, Rabasha B, Liu D, Zhang G, Margolais C, Ashenberg O, Ott PA, Buchbinder EI, Haq R, Hodi FS, Boland GM, Sullivan RJ, Frederick DT, Miao B, Moll T, Flaherty KT, Herlyn M, Jenkins RW, Thummalapalli R, Kowalczyk MS, Cañadas I, Schilling B, Cartwright ANR, Luoma AM, Malu S, Hwu P, Bernatchez C, Forget MA, Barbie DA, Shalek AK, Tirosh I, Sorger PK, Wucherpfennig K, Van Allen EM, Schadendorf D, Johnson BE, Rotem A, Rozenblatt-Rosen O, Garraway LA, Yoon CH*, Izar B, Regev A. A Cancer Cell Program Promotes T Cell Exclusion and Resistance to Checkpoint Blockade. Cell 2018 Nov 1;175(4):984-997.e24. 89

doi: 10.1016/j.cell.2018.09.006. PubMed PMID: 30388455; PubMed Central PMCID: PMC6410377. [*Co- senior author] Bertagnolli MM, Anderson B, Norsworthy K, Piantadosi S, Quina A, Schilsky RL, Miller RS, Khozin S. Status Update on Data Required to Build a Learning Health System. J Clin Oncol 2020; 38(14): 1602-1607. PMID 32209005. L. Kuo, H. Lyu, M. Jarman, N. Melnitchouk, G. Doherty, D. Smink, N. Cho. Gender disparity in awards in general surgery residency programs. JAMA Surg. 2020. D. EDUCATIONAL ACTIVITIES The division has a commitment to education at all levels: medical students, residents, fellows, and faculty. Several division members play significant roles in medical student education: • Dr. Cho serves as associate clerkship director for second-year HMS students during their three- month surgery clerkship. • Dr. Fairweather serves as overall course director for the medical student advanced elective in surgery, overseeing all advanced surgery sub-internships. • Dr. Clancy has served as course director for the advanced surgical oncology clerkship rotation for senior medical students. • Dr. Clancy and Dr. Raut have received one or more faculty awards for medical student teaching. Resident training is a major focus of division members and takes place continually on the inpatient surgical services. All surgical trainees rotate through these services at several points during their five- year clinical training program. Resident education includes separate dedicated oncology service meetings for sarcoma, hepatobiliary, cutaneous oncology and endocrine surgery, where the emphasis for each is placed on clinical-pathologic correlations. Two faculty members have leadership roles in resident teaching. Dr. Nehs and Dr. Fairweather both serve as associate program directors for the General Surgery Residency Program. Drs. Clancy, Nehs, Raut and Wang were each awarded the Matson Award (from the full cadre of General Surgery Residents) and/or the Wilson Award (from the chief residents) for excellence in resident teaching. The division supports two fellowship programs. For more details about each of these, please see Appendix 3. • Dr. Fairweather is the program director for the complex general surgical oncology (CGSO) fellowship, which is a joint program with Dana-Farber. This program is highly competitive and accepts one fellow per year. • Dr. Nehs has served as program director for the one-year endocrine surgery fellowship which 90

recently became a combined program with MGH. This fellowship has become one of the most prestigious endocrine surgery training programs in the country. In 2010, the division piloted a new program for maintenance of clinical competency. In this co-surgery program, each division member performs at least one operation per year as the first assistant to another division member. During the operation, the division member receives critical feedback and instruction from the surgeon of record. This program was enthusiastically embraced by the division members, who saw it as a unique opportunity for evaluation and mentorship by their colleagues. Faculty Development The Brigham Leadership Program is an educational program for mid‐career physicians, scientists, and nursing/clinical directors in a management role. The program is designed to enhance the participants’ leadership capacity and ability to lead complex projects and teams. Two division members, Dr. Clancy and Dr. Raut, have completed this program since its inception in 2007, resulting in significant improvements to the division’s clinical programs. E. CURRENT CHALLENGES Aging Facility: Brigham facilities are quite dated. Most patient rooms are “semiprivate” which makes it challenging to hold private conversations with patients about sensitive topics. OR facilities also need to be modernized; most surgical oncology cases are done in OR rooms that are among the oldest and smallest on campus. In addition, more robots are necessary to meet the demand of the rapidly growing program in robotic surgical oncology. Research: There is capacity to improve the research portfolio of the faculty. Strategic hiring in the future will address this issue. Competitive Market: Boston has many high-quality medical facilities, so competition for patients can be fierce. We have capitalized on opportunities where possible, developing strong relationships with surgeons at other facilities in the relevant disease centers. Goals: At times, pressures for clinical productivity seem to clash with plans for academic advancement. This is particularly challenging for surgeons who perform cases with low RVUs per case. Dana-Farber Relationship: While surgery is integral to cancer care, surgical oncologists are in many ways considered second-class citizens at DFCI. DFCI leadership should include surgeons as clinical peers of equal footing in all the disease centers and should also include surgeons as equals in administrative, research and educational efforts. There is much to be gained for all with better collaboration. 91

F. VISION AND FUTURE OPPORTUNITIES Clinical Growth: We will expand our division with strategic hiring to fill clinical needs, while also ensuring that new hires add unique research or other non-clinical skills to complement the current faculty’s expertise. New hires will be recruited with an eye toward building a more diverse faculty to better reflect the demographics of the region and the country. We also hope to expand our footprint by carefully staffing regional clinics, satellites and affiliates. This will help bring our expertise closer to the community for appropriate diseases or conditions. However, we will do so in a manner that is not overly burdensome to faculty. Innovation: We will continue to adopt newer techniques or approaches, such as robotic surgery, provided that they offer advantages over current standards, and are safe and fiscally responsible. Research: We will look to improve our research productivity, including clinical trials, laboratory science, health services research and implementation, and grant success. Education: We will continue to support fellowships in complex general surgical oncology and endocrine surgery. 92

Thoracic Surgery A. OVERVIEW The Division of Thoracic Surgery was created in 1988 and is among the largest programs of its kind in the world. Under the leadership of Raphael Bueno, MD, the division is primarily focused on providing a superlative patient experience, based on the latest science and technology for multidisciplinary care in thoracic surgery. Additional thoracic programs have been established in other clinical departments and care settings, such as Anesthesiology, Critical Care, Radiology, Radiation Oncology, Medical Oncology (at Dana-Farber Cancer Institute), Pathology and Pulmonary Medicine. Functionally, the division utilizes specific operating rooms staffed by specialized teams of nurses and physicians, as well as a general thoracic surgical ICU and step-down patient floors with a well-trained nursing team. The team also includes physician assistants, social workers, nutritionists, respiratory therapists and other health care workers specializing in thoracic surgery. All of these specialists at the Brigham and DFCI work together collaboratively in many ways to provide the best patient care, education and innovations. In 2014, the divisions of Thoracic Surgery and Pulmonary and Critical Care Medicine worked together to form the first Lung Center in the United States. This multidisciplinary clinical effort involves all the physicians who work with lung patients, bringing them into a single unified collaborative center to improve patient access, outcomes and experience. In parallel, we created the Lung Research Center through the Brigham Research Institute to foster research and innovation in lung care. While providing outstanding patient care in a timely manner remains the primary objective of the division, secondary and important objectives include prioritizing innovation and research; offering innovative clinical trials in collaboration with other stakeholders; and producing tomorrow’s leaders in the field by training residents, fellows and medical students. The following goals are aligned with our focus in these areas: • Achieving equity and equality to provide the best care for all our patients in the community and elsewhere • Mentoring faculty so they may reach promotion and their maximum potential • Supporting our entire team of physician assistants, nurses, administrators and others with continuing education and advancement opportunities • Creating partnerships in the New England region by developing thoracic programs in other hospitals that are supported by our staff and provide easy access to our specialized programs. 93

Changes Over the Past Five Years • Recruited 17 faculty members, including the expansion of research faculty • Promoted 11 faculty members • Created mentoring programs for faculty and residents/fellows and provided support to faculty to become members in the leadership of several national/international specialty organizations • Developed two collaborative tumor boards (esophageal and lung) • Raised millions of dollars to create three Brigham distinguished chairs and one research fund • Expanded the lung transplant and ECMO services • Increased network sites from three to six • Expanded the research enterprise in terms of infrastructure, output and funding • Developed new infrastructure supports such as the prospective patient database and multiple specialized retrospective databases • Expanded the operating room footprint to six rooms daily, including a procedure room • Added a thoracic surgery focused endoscopic robot (Ion) and a new Xi robot (funded by Intuitive as part of a research program) • Focused on diversity — 21% of the thoracic service faculty are female (nationally, it is 6-8%) — and launched the Massachusetts Women in Thoracic Surgery Group • Created outreach programs to mentor HMS students • Expanded number of CME courses in Boston and elsewhere • Developed the I-6 residency program track in thoracic surgery • Created Cardiothoracic Surgery Grand Rounds • Formed multiple new education conferences and formats for the residents and fellows • Designed new educational platforms for allied health workers (physician assistants, nurses, etc.) B. CLINICAL SERVICES Brigham Thoracic Surgery is currently the largest service in the U.S. It includes 24 thoracic surgery attendings who cover the Brigham and six other locations. Each of the attendings works at the Brigham most of the time, as well as at one additional site. The division leads the market with 22% of the thoracic surgery performed in eastern Massachusetts. During the past fiscal year, thoracic surgeons performed 3,766 operations of all types at the Brigham. In addition, our surgeons also performed: • 236 cases at Milford Regional Medical Center • 412 cases at South Shore Hospital • 277 cases at Boston VA Medical Center • 233 cases at Kent Hospital • 179 cases at Good Samaritan Medical Center 94

The network hospitals are designed to provide low- to mid-complexity patient care in the community, whereas patients with more complex cases get transferred to the Brigham for surgical care. The thoracic surgery service at the Brigham is divided into five sections. • Critical Care • Endoscopic Lung Procedure • Esophageal Surgery • Lung Surgery • Lung Transplantation and ECMO Each section has a chief whose responsibility is to ensure quality, outcomes, innovation, education, mentorship, oversight and CME activity. Through collaboration with colleagues in the complementary departments, as described previously, we provide comprehensive care in all facets of thoracic and foregut surgery. We have achieved international/national recognition in the care of mesothelioma patients via our International Mesothelioma Program, as well as minimally invasive esophageal and lung surgery. Some of our faculty have national and regional leadership roles in lung transplantation and ECMO. Our surgeons are collaborative within and outside the DOS. They participate in multiple committees and hold leadership positions in the DOS, hospital and BWPO. We also have a large number of robotic- trained thoracic surgeons (10) and one of the world’s leading uniportal minimally invasive surgeons. Our thoracic surgical ICU is one of a handful of independent units in the U.S. Complication and mortality rates for the division are below expected for our patient type and acuity. Our access rate is the lowest in the hospital system, with more than 90% of patients getting an appointment within eight days of referral. C. RESEARCH ACTIVITIES The division is renowned for innovative care and leadership in the fields of thoracic oncology, transplantation and minimally invasive surgical techniques. Clinical care remains at the cutting edge of treatment because of the team’s commitment to clinical and basic science research. In the last few decades, basic research studies, clinical trials and scientific discoveries have led the division to revolutionary innovations in the field of thoracic surgery. Research projects include: • Tissue analysis and typing to develop biomarkers for prognosis and diagnosis in cancer • Characterization of the tumor genetic structure and function, with emphasis on developing new therapies 95

• Investigation of the adaptive processes involved in blood vessel growth (angiogenesis) and lung regeneration Furthermore, the division is involved in clinical studies such as investigating new devices to aid in treatment, localization and tumor excision; developing new protocols to reduce postoperative stay and promote recovery; and improving patients’ lifestyles and reducing morbidities before and after surgery. Research labs within the division include: Laboratory of Adaptive and Regenerative Biology (Steven J. Mentzer, MD) This lab focuses on processes fundamental to normal tissue repair and regeneration; the perturbation of these processes is a major contributor to lung disease and lung cancer. Thoracic Surgery Oncology Laboratory (Raphael Bueno, MD) This lab is dedicated to the development of novel translational tools in genomics that can be used to identify candidate predictive and diagnostic biomarkers, as well as novel targets for therapy, mesothelioma and lung cancer. Cardiothoracic Transplant and Advanced Mechanical Therapeutics Laboratory (Hari Mallidi, MD) This lab focuses on the investigation of advanced surgical therapeutics for end-stage heart and lung disease. Studies range from examining the pathophysiology of organ dysfunction during warm ischemia, to reporting the outcomes in patients undergoing transplantation or mechanical circulatory support. Databases and Surgical Outcomes Laboratory (Michael T. Jaklitsch, MD) This lab uses major sources of data (the Thoracic Surgery Divisional Database and other available large databases) to test hypotheses of associations of risk of disease, risk of poor outcomes and probability of outstanding outcomes. The databases have also been used by our group to explore disparities in health, geographic variations of disease and disproportionate risks that come with aging. Finally, we have developed and patented multiple innovations and have spun out at least one company with the help of the Brigham Innovation Office. Key Grants Name of study: Cancer Immunotherapy Research with imCORE Program PI: Raphael Bueno, MD Funding source: Dana-Farber Cancer Institute Funding amount: $2,207,441 Brief description of the study w/goals and objectives: A collaboration with Genentech looking at the single-cell sequencing of 100 lung cancer patients. Name of study: Comparative Effectiveness of Limited Resection vs. Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer PI: Scott Swanson, MD 96