José Gaston Guillem, MD, MPH, MBA joins the Department of Surgery as the new Chief and Professor in the Division of Gastrointestinal Surgery. He discusses what inspired him to become a doctor, how influential mentors lead to his specialty in colorectal surgery and his goals for the GI Division.
Dr. Guillem received his undergraduate degree from New York University in 1978 before earning his medical degree at Yale University in 1983. He completed his General Surgery residency training at Columbia Presbyterian Medical Center, during which time he also pursued a two-year research fellowship in colon carcinogenesis and earned a Master of Public Health in Epidemiology at Yale. After completing a Colorectal Surgery Fellowship at Lahey Clinic Medical Center, he accepted a position at Memorial Sloan-Kettering Cancer Center. From 1991 through 2020, he specialized in caring for people with primary and recurrent colon and rectal cancer, early-onset colorectal cancer, and hereditary colorectal cancer. He also established and became the Director of MSK’s Hereditary Colorectal Cancer Family Registry, an important tool for patients, families, and doctors around the world. His academic appointment was at Cornell University, rising through the ranks to Professor in 2006.
Dr. Guillem’s research has been funded by the National Institutes of Health/National Cancer Institute, the American Cancer Society, and the American Society of Colon and Rectal Surgeons Research Foundation (ASCRSRF). He has investigated the causes of colorectal cancer growth and metastases, early-onset and inherited forms of the disease, as well as rectal cancer response to preoperative chemoradiation therapy.
He has co-authored more than 300 journal articles and book chapters, and lectured extensively, both nationally and internationally. He has served on the editorial boards of ten leading medical journals, including the Journal of Clinical Oncology and the Annals of Surgery. He has held several leadership positions regionally and nationally, including President of the ASCRSRF, co-founder and President of the Collaborative Group of the Americas on Inherited Colorectal Cancer, President of the Spanish American Medical Society of New York, and President of the New York Surgical Society.
In 2016, Dr. Guillem attended the Executive Leadership Program in Health Policy and Management at Brandeis University, facilitated by a Health Policy Scholarship awarded by the American College of Surgeons and the American Society of Colon and Rectal Surgeons. He subsequently enrolled in the Brandeis MBA for Physicians Program to obtain further training in leadership, strategic and operational management, health policy, healthcare technology, and information systems.
What inspired you to become a doctor?
A multitude of things pushed me in the direction of becoming a doctor. My interest in medicine was ignited by my great uncle. He was a physician in Ecuador, a great role model for me. He was a Radiologist but was also involved with medicine at the level of primary care. He visited the United States when I was in high school and I have vivid recollections of him asking me what I was going to study in college. I wasn’t sure at the time.
He suggested I consider Medicine because it offered great opportunities to be involved in multiple different areas. “If you like helping people, you get the chance to take care of patients. If you like to do research, teach or be a leader, you can do that too. So, it offers opportunities to be involved in multiple areas of medicine with the added benefit that you’ll always have a job”. I thought that was a very timely suggestion and it’s how I went into the pre-med path.
In undergraduate at NYU, I majored in Biochemistry and minored in Religious Studies. I went to medical school with the intention of becoming a psychiatrist. Over time that intention evolved into a desire to pursue a career in Epidemiology and Public Health, which then changed to internal medicine and eventually I decided surgery was the best path for me.
Why make the shift to surgery when you had a different plan in mind?
In medical school one of the most fascinating courses I took was Epidemiology. I was drawn to that path, which eventually led me to my MPH in Epidemiology. I did a summer project between my first and second years of medical school and went back to Ecuador to study the transmission of Yellow Fever virus in the jungle. After that experience, I realized I didn’t want to be a psychiatrist and started thinking more about public health. I was going to join the CDC and work with infectious diseases.
As medical school progressed, I moved into my clinical rotations and loved them all. I did very well in my medical rotation. However, I began to be drawn to surgery. As a surgeon, you see immediate results from your interventions. If you had a problem, you fixed it and you moved on to the next patient. At the gut level that really appealed to me.
I had a wonderful mentor at Yale named Dr. Thomas Duffy, an Oncologist. He thought I should pursue Internal Medicine. I told him I wasn’t sure what I wanted to do and he gave me great advice that I now share with my residents and fellows, “You should think worst-case scenarios. Imagine that you’re not going to be at an Ivory Tower institution but instead you’re going to be practicing in the middle of nowhere.”
So that’s what I did. Thanks to Dr. Duffy I was able to distill my future. I imagined myself in a small town in the middle of the country. If I chose the path of Internist, I imagined I would probably be treating the common cold, the flu, depression, back pain, diabetes, CHF, etc. If I chose the path of country surgeon, I’d probably be doing simple hernia surgery, appendectomies, gall bladder surgeries, things of that sort. I thought long and hard and decided I wanted to be similar to a concert pianist. I wanted to hone my craft and become the world’s greatest surgeon. Make the smallest incision and take out the appendix in the fastest, most elegant way possible and that seemed to be very fulfilling to me. That’s how I decided to pursue surgery.
For me, it was a great decision because I love surgery. I’m really passionate about being in the right surgical and anatomical plane and the aesthetics of surgery and seeing how this degree of attention to detail translates into improved patient outcome really appeals to me. While research gives me the opportunity to delve deeply into a focused question with long-term planning, surgery gives me the immediate gratification of helping patients with a surgical intervention day in and day out. It has been a nice blend for me.
How did you decide to pursue your current specialty? Has it met your expectations?
I went to Columbia-Presbyterian Medical Center for my General Surgery Residency with an interest in vascular surgery because I was very attracted to the technical aspects of it. Vascular surgery in those days was and still remains very precise and meticulous. Technique is of paramount importance. It’s always been my nature to be drawn to that.
When I was at Columbia, I had the opportunity to work with many great mentors. Two, in particular, had a huge impact on my career. One was a clinical mentor and the other a research mentor. My clinical mentor was Dr. Kenneth Forde who was a pioneer in endoscopy and colonoscopy. He had a phenomenal database on colonoscopies; this was before electronic databases. I asked if I could have access to that database. With my public health and elementary statistics background, it was a gold mine for me and we wrote a couple of great papers. We developed a wonderful friendship and I began to think about GI surgery.
At that time I was a second-year resident and there was an opportunity to do a research fellowship. I looked around Columbia and there was a great scientist named Dr. I Bernard Weinstein who was the Director of the Cancer Center and his lab at the time was cloning Protein Kinase C, PKC.
I asked to work with him and fortunately for me, he took a clinician into his lab full of PhDs. I spent two years with him and his superb crew of researchers. I made lots of great friends and took on five different projects and that’s when I caught the bug. I just loved the research and it all began to focus on colorectal cancer. I went with a question “Where does PKC fit into colon carcinogenesis?” It was a phenomenal marriage. He was brilliant, he became a great friend and guided me to the right collaborators. We wrote a lot of great papers. That was, I think, what allowed me to get my job at Sloan-Kettering. I was at the right place at the right time with a phenomenal mentor.
When I was trying to decide what surgical specialty to go into, I knew it was going to have something to do with cancer surgery. I went to Sloan-Kettering for an interview for a Surgical Oncology Fellowship. Dr. Murray Brennan, who was the Chair said to me with his New Zealand accent and humorist personality, “Jose, your CV reeks of colorectal cancer. Why would you want to do Surgical Oncology, which is so broad? You’ve already defined yourself as a colorectal cancer doctor. Why not do a colorectal surgery fellowship?”
It was like a light bulb went off. I hadn’t thought about that. So, I did the Colorectal Fellowship and learned a lot about benign disorders, a lot about inflammatory bowel disease and a lot about colorectal cancer.
What are your contributions to your specialty?
Due to my intrinsic interest in surgical technique and enormous volume of colorectal and anal cancer patients that I have been privileged to treat over my career, I have been able to contribute to advancing surgical approaches. These approaches have improved our ability to completely remove cancers while preserving important vital structures that have led to increased survival while minimizing changes in GI, bladder and sexual function. There’s a challenge in getting the cancer out completely while leaving nerves, vessels and other organs behind intact. Our goal is to leave people with both oncological and functional success. Basically, we want to help them have a good quality of life.
Another of my contributions has been the assessment of rectal cancer response to preoperative chemoradiation therapy and how we can use that information to alter the surgical approach.
We started to study why some similarly bulky rectal cancers responded better than others. We wanted to understand why some became axial, while others remained grapefruit-like in size and shape and yet others were completely eradicated with chemoradiation therapy alone. That led to my first NIH grant. We were funded to look at a head-to-head comparison between PET scan and CT scan to see which predicted pathological response. The unfortunate reality is that neither PET nor CT scan can predict response adequately enough for us to use it clinically. That was the downside of it.
The upside is that the question remains unanswered. Now the question is which tracer, which modality is going to be able to tell us who has experienced a complete pathological response.
Another contribution was the creation of the Hereditary Colorectal Cancer Family Registry. When I was a resident at Columbia with Dr. Forde, President Reagan developed colon cancer and around the same time, his brother also developed colorectal cancer. This drew the public’s attention to the familial aspect of colorectal cancer. I designed a study at that time that invited asymptomatic individuals who had a first-degree relative with colorectal cancer to come in for a free colonoscopy. They were allowed to invite their spouse/significant other who had no family history of colorectal cancer for a free colonoscopy as well. So, we did a prospective screening colonoscopy study on first degree relatives of colorectal cancer patients and non-first-degree relatives as controls, and it yielded some very interesting data.
That study led to the establishment of the Registry when I went to Sloan-Kettering. In addition to registering individuals with a positive family history for colorectal cancer and inherited syndromes we also included data on early-age-of-onset colorectal cancer patients. Today that is a big concern and we are trying to figure out why young people in their 40s and younger are getting colorectal cancer in an unprecedented manner. This is a major interest of mine and I hope to develop collaborations with clinicians and scientists at UNC and elsewhere who are also trying to understand the etiology of early age-of-onset colorectal cancer as well as its prevention and clinical management.
What brought you to the Department of Surgery at UNC?
I was approached by Dr. Kibbe, the Chair of Surgery, to consider the Chief of GI Surgery position at UNC. I had always known of the Department of Surgery because of its clinical strength. When I interviewed for the position and met clinicians from different surgical and nonsurgical Divisions as well as Nurses, Clinical Genetic Counselors, scientists, and administrators, I was just blown away by the caliber of these individuals and their level of expertise and commitment.
I think UNC is a great institution and I believe Dr. Kibbe has invigorated the Department of Surgery with her strong commitment to clinical excellence, education and research. This along with the prevailing collaborative institutional spirit and the opportunity to grow the Division of GI Surgery was a big draw for me.
What are some goals you would like to achieve as Chief of the GI Division during your time at UNC Surgery?
My vision for the GI Division is to make it the premier place for patients looking to get the best possible personal care anywhere for their GI surgical problems. I’d like to see it be the place where quality, impactful research is conducted that leads to improvement in standards of care for both upper and lower GI disorders. I’d also like to see it become the Division where trainees worldwide would love to come because of its collegial environment and the energy of being at the forefront of quality care, research, and innovation.
As surgeons it is critical to be technically competent and value the patient’s wishes and results as if they were a family member. Along the same line, it is important to realize that innovation and improvement in quality care come from research, those two things have to go hand-in-hand.
What is one thing you wish your patients or coworkers knew about you before they meet you?
I consider it a privilege to be a physician, a surgeon. I think the relationship between a patient and their surgeon is powerful. There’s a lot of trust that has to be established from the beginning and communication is important. I value that. If I am entrusted with someone else’s health and life, I treat them as if I were in their position. This allows me to always go the extra mile. By virtue of my vast surgical experience, past leadership opportunities and great mentoring, I think I’m prepared to lead the GI Division in delivering optimal surgical care and promoting education and research. I’m looking forward to doing that here at UNC and in North Carolina.
If you could pick the brain of someone alive or dead, who would it be and why?
I would love to pick the brains of my clinical and research mentors, Drs. Kenneth Forde and Bernie Weinstein. Kenneth Forde represents people skills. He was a phenomenal African-American who overcame the challenges of being an African-American training in Surgery at Columbia Presbyterian Medical Center during the 1970s. He ascended from being a clinician who was initially marginalized to eventually becoming a Trustee of Columbia University. I think all of this is a credit to his people skills and perseverance.
Bernie Weinstein was a renowned scientist, a Renaissance man, a big picture kind of guy. He was able to drill down to the specifics while still being able to see outside the box. I think it would be wonderful to sit down with them again and talk science, talk research, and talk people.
If you could give your younger self one piece of advice, what would it be?
I would tell my younger self to follow up on leads that at the moment may not appear to be unique. Leads that come to mind or suggestions that you thought were intriguing but you might have not followed up on them because something else distracted you. There have been numerous opportunities where I’ve looked back and said, “I already thought of that, why didn’t I pursue that?”
I’m happy with what I’ve accomplished thus far. But in this new chapter of my life I’m going to follow up on some of these ideas that I think can translate into novel advancements; especially now that I know how to mobilize collaborators. I think we can do some great innovative things.
How would you describe yourself in one word?
If you could have one superpower, what would it be and why?
I would like to be able to see the future and be able to anticipate crises such as COVID 19 and identify needs earlier and better redirect resources.