Ralph S. Greco, M.D. is the Johnson & Johnson Distinguished Professor, Emeritus at the Stanford University School of Medicine. He is also the immediate past Chief of the Division of General Surgery at Stanford and past Director of the General Surgery Training Program. Dr. Greco joined the faculty at Stanford in the year 2000. He graduated cum laude from Fordham University in 1964 and from the Yale University School of Medicine in 1968. His internship and residency were also served at Yale New Haven Hospital where he was chief resident in 1972-73. After two years of military service, he became an Assistant Professor at the Rutgers Medical School in 1975. He became Chief of the Division of General Surgery and Program Director in 1982 and Chief of Surgery at Robert Wood Johnson University Hospital in 1997.

Dr. Greco is a member of the American Surgical Association, the Society of University Surgeons, the Society for Biomaterials and the Association of Program Directors in Surgery, among many other surgical societies. He is board certified in General Surgery and is a Fellow of the American College of Surgeons. Dr. Greco has been the recipient of research grants from the National Heart, Lung and Blood Institute and served as a consultant to the NHLBI and the NSF. Dr. Greco is the recipient of six patents on various aspects of antibiotic bonding and has published more than 100 papers in the scientific literature. His research interest is focused on biomaterials, the host response to implantable biomaterial surfaces, and surface modification of biomaterials. When he arrived at Stanford he began a collaboration with Friedrich Prinz, Chair of Mechanical Engineering in a related, but new area, namely the nanofabrication of new biomaterial surfaces and their potential application to a new generation of biomaterials for clinical applications.

At Stanford, Dr, Greco is a surgical oncologist and currently is surgical lead of the Melanoma Program. In 2010, Dr. Greco became interested in Resident Well Being in the aftermath of the death by suicide of one of the very finest residents who graduated from the Stanford General Surgery Training Program. Losing someone only 4 months after starting a fellowship elsewhere was terribly disturbing to all the Stanford residents and the faculty. Together with Drs Claudia Mueller and Rachel Callcut and residents Greg Magee, Mediget Teshome, Yulia Zak, and Arghavan Salles, The Balance in Life Program was developed and rolled out in July 2011. A recipient of the Palmer Award from the ACGME in 2006, Dr. Greco then received the prestigious John Gienapp Award, the ACGME’s highest honor, largely for his work on Resident Wellness in 2012.

Dr. Greco summarizes his work on well being by saying, “Surgeons can be extremely proud of how well they have taught their residents to take the best care of the sickest patients. Now it is time to teach them how to take care of themselves.” Each year 400 physicians die by suicide in the US, the equivalent of 3 medical school classes at Yale, Stanford and John Hopkins. Giving residents the tools to deal with vicissitudes of life as a surgeon will provide them with the skillset they will need throughout their careers.

Academic Appointments

Administrative Appointments

  • Johnson & Johnson Distinguished Professor-Emeritus, Stanford University School of Medicine (2015 - Present)
  • Johnson & Johnson Distinguished Professor, Stanford University School of Medicine (2000 - 2015)
  • Director, General Surgery Residency Program, Stanford University School of Medicine (2000 - 2009)
  • Chief, Division of General Surgery, Stanford University School of Medicine (2000 - 2006)

Honors & Awards

  • Cum Laude Graduation Honors, Fordham University (1964)
  • 1000 Best Doctors in America, American Health Fitness of Body and Mind (1996)
  • The Wakely Prize - Runner up, The Lancet (1997)
  • The Parker J. Palmer Courage to Teach Award, Accreditation Council for Graduate Medical Education (ACGME) (2006)
  • The John C. Gienapp Award, Accreditation Council for Graduate Medical Education (ACGME) (2012)
  • Shumway Award, Stanford University (2016)

Professional Education

  • MD, Yale Medical School (1968)
  • Fellow, American Cancer Society (1971)

Community and International Work

  • Board of Directors of Hopital Albert Schweitzer, Haiti


    International Health in Haiti



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

Application of Micro/Nanotechnology to Biological Systems.

Clinical Trials

  • Lymph Node Mapping Using Indocyanine Green Solution in Diagnosing Patients With Malignant Melanoma Not Recruiting

    This clinical trial compares and contrasts lymph node mapping using indocyanine green (IC-GREEN), isosulfan blue (ISB), and TSC and Lymphoscintigraphy with 99-technetium (99Tc) sulfur colloid (TSC). Study participants with malignant melanoma will undergo all 3 evaluations to assess the extent of the spread of the melanoma.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ralph S. Greco, 650-736-1355.

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  • Trilogy Stereotactic Body Radiotherapy for Pancreatic Cancer Not Recruiting

    This study will assess the efficacy of treating locally advanced pancreatic cancer using Stereotactic Body Radiotherapy (using Trilogy) and Gemcitabine

    Stanford is currently not accepting patients for this trial. For more information, please contact Jeff Kim, (650) 498 - 7703.

    View full details


All Publications

  • Perceived Value of a Program to Promote Surgical Resident Well-being. Journal of surgical education Salles, A., Liebert, C. A., Esquivel, M., Greco, R. S., Henry, R., Mueller, C. 2017


    The demands of surgical residency are intense and threaten not only trainees' physical wellness, but also risk depression, burnout, and suicide. Our residency program implemented a multifaceted Balance in Life program that is designed to improve residents' well-being. The purpose of this study was to evaluate the program utilization and perceived value by residents.Residents (n = 56, 76% response rate) were invited to participate in a voluntary survey from December 2013 to February 2014 regarding utilization, barriers to use, and perceived value of 6 program components (refrigerator, After Hours Guide, psychological counseling sessions, Resident Mentorship Program, Class Representative System, and social events). They were also asked questions about psychological well-being, burnout, grit, and sleep and exercise habits before and after implementation of the program.The most valued components of the program were the refrigerator (mean = 4.61) and the psychological counseling sessions (mean = 3.58), followed by social events (mean = 3.48), the Resident Mentorship Program (mean = 2.79), the Class Representative System (mean = 2.62), and the After Hours Guide (mean = 2.10). When residents were asked how they would allocate $100 among the different programs, the majority was allocated to the refrigerator ($54.31), social events ($26.43), and counseling sessions ($24.06). There was no change in psychological well-being or burnout after the program. Residents had higher levels of grit (β = 0.26, p < 0.01) and exercised (β = 1.02, p < 0.001) and slept (β = 1.17, p < 0.0001) more after the program was implemented.This study demonstrated that a multifaceted program to improve the well-being of trainees is feasible, highly valued, and positively perceived by the residents. Further research is needed to quantify the effectiveness and longitudinal impact such a program has on resident depression, burnout, and other psychological factors.

    View details for DOI 10.1016/j.jsurg.2017.04.006

    View details for PubMedID 28457875

  • Prevalence and predictors of depression among general surgery residents. American journal of surgery Lin, D. T., Liebert, C. A., Esquivel, M. M., Tran, J., Lau, J. N., Greco, R. S., Mueller, C. M., Salles, A. 2017; 213 (2): 313-317


    Recent resident suicides have highlighted the need to address depression among medical trainees. This study sought to identify the prevalence and predictors of depression among surgical residents.Surgical residents at a single institution were surveyed. Depression and personal traits were assessed using validated measures; participant demographics were also obtained.73 residents completed the survey (response rate 63%). 36% met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. In multivariate linear regression analyses controlling for demographic factors, trait emotional intelligence alone was a significant inverse predictor of depression (β = -0.60, p < 0.001).Depression is prevalent among general surgery residents. Identifying protective factors and at-risk populations may allow for effective initiatives to be developed to address depression, and optimize the mental health of trainees.The aim of this study is to identify the prevalence and predictors of depression among surgical trainees. Over one third of respondents met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. Among demographic and personal trait variables, emotional intelligence emerged as a significant inverse predictor of depression.

    View details for DOI 10.1016/j.amjsurg.2016.10.017

    View details for PubMedID 28017297

  • Grit as a predictor of risk of attrition in surgical residency. American journal of surgery Salles, A., Lin, D., Liebert, C., Esquivel, M., Lau, J. N., Greco, R. S., Mueller, C. 2017; 213 (2): 288-291


    Grit, a measure of perseverance, has been shown to predict resident well-being. In this study we assess the relationship between grit and attrition.We collected survey data from residents in a single institution over two consecutive years. All residents in general surgery were invited to participate (N = 115). Grit and psychological well-being were assessed using validated measures. Risk of attrition was measured using survey items.73 residents participated (63% response rate). Grit was positively correlated with general psychological well-being (r = 0.30, p < 0.05) and inversely correlated with depression (r = -0.25, p < 0.05) and risk of attrition (r = -0.37, p < 0.01). In regression analyses, grit was positively predictive of well-being (B = 0.77, t = 2.96, p < 0.01) and negatively predictive of depression (B = -0.28 t = -2.74, p < 0.01) and attrition (B = -0.99, t = -2.53, p < 0.05).Attrition is a costly and disruptive problem in residency. Grit is a quick, reliable measure which appears to be predictive of attrition risk in this single-institution study.

    View details for DOI 10.1016/j.amjsurg.2016.10.012

    View details for PubMedID 27932088

  • Promoting Balance in the Lives of Resident Physicians: A Call to Action. JAMA surgery Salles, A., Liebert, C. A., Greco, R. S. 2015; 150 (7): 607-608

    View details for DOI 10.1001/jamasurg.2015.0257

    View details for PubMedID 25992632

  • Indocyanine Green and Fluorescence Lymphangiography for Sentinel Lymph Node Identification in Cutaneous Melanoma JOURNAL OF SURGICAL ONCOLOGY Cloyd, J. M., Wapnir, I. L., Read, B. M., Swetter, S., Greco, R. S. 2014; 110 (7): 888-892

    View details for DOI 10.1002/jso.23745

    View details for Web of Science ID 000344552200020

  • Indocyanine green and fluorescence lymphangiography for sentinel lymph node identification in cutaneous melanoma. Journal of surgical oncology Cloyd, J. M., Wapnir, I. L., Read, B. M., Swetter, S., Greco, R. S. 2014; 110 (7): 888-892


    Sentinel lymph node (SLN) biopsy has become the standard method of determining regional lymph node involvement in cutaneous melanoma. Although traditionally performed via injection of radioisotope tracers and blue dyes, fluorescent lymphangiography with indocyanine green (ICG) is an attractive alternative.Fifty two consecutive patients with cutaneous melanoma of the trunk or extremities underwent SLNB. Preoperative lymphoscintigraphy was performed with technetium-99m sulfur colloid (TSC). Peritumoral intradermal injection of isosulfan blue (ISB) and ICG was then performed. Successful identification of a sentinel lymph node via each modality was then assessed.A total of 77 lymph nodes were identified from the 52 patients (range 1-3). The majority of melanomas were extremity-based, superficial spreading type, and had SLN localized to the axilla. There were no complications related to IcG administration. Rates of SLN detection were 96.2% for TSC, 59.6% for ISB, and 88.5% for IcG (P < 0.05 for ICG vs ISB). On univariate logistic regression analysis, no factors were found to be associated with failure of ICG.Fluorescent lymphangiography using ICG is an effective method of SLN identification in patients with cutaneous melanoma of the trunk and extremities. When ICG and TSC are used in combination, ISB offers no additional advantage and may be safely omitted. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.

    View details for DOI 10.1002/jso.23745

    View details for PubMedID 25124992

  • Health behaviors and needs of melanoma survivors SUPPORTIVE CARE IN CANCER Palesh, O., Aldridge-Gerry, A., Bugos, K., Pickham, D., Chen, J. J., Greco, R., Swetter, S. M. 2014; 22 (11): 2973-2980
  • Health behaviors and needs of melanoma survivors. Supportive care in cancer Palesh, O., Aldridge-Gerry, A., Bugos, K., Pickham, D., Chen, J. J., Greco, R., Swetter, S. M. 2014; 22 (11): 2973-2980


    Little is known about melanoma survivors' long-term symptoms, sun protection practices, and support needs from health providers.Melanoma survivors treated at Stanford Cancer Center from 1995 through 2011 were invited to complete a heath needs survey. We compared responses of survivors by sex, education, time since diagnosis (long-term vs. short-term survivors), and extent of treatment received (wide local excision (WLE) alone versus WLE plus additional surgical or medical treatment (WLE+)).One hundred sixty melanoma survivors (51 % male; 61 % long-term; 73 % WLE+) provided evaluable data. On average, patients were 62 years of age (SD = 14), highly educated (75 % college degree), and Caucasian (94 %). Overall, participants rated anxiety as the most prevalent symptom (34 %). Seventy percent reported that their health provider did not address their symptoms, and 53 % requested education about melanoma-specific issues. Following treatment, women spent significantly less time seeking a tan compared with men (p = 0.01), had more extremity swelling (p = 0.014), and expressed higher need for additional services (p = 0.03). Long-term survivors decreased their use of tanning beds (p = 0.03) and time spent seeking a tan (p = 0.002) and were less likely to receive skin screening every 3-6 months (p < 0.001) compared with short-term survivors. WLE+ survivors reported greater physical long-term effects than WLE survivors (p ≤ 0.001) following treatment.Melanoma survivors experience continuing symptoms long after treatment, namely anxiety, and they express a need for information about long-term melanoma effects, psychosocial support, and prevention of further skin cancer.

    View details for DOI 10.1007/s00520-014-2286-0

    View details for PubMedID 24879390

  • Symbiotic or Parasitic? A Review of the Literature on the Impact of Fellowships on Surgical Residents ANNALS OF SURGERY Plerhoples, T. A., Greco, R. S., Krummel, T. M., Melcher, M. L. 2012; 256 (6): 904-908


    We conducted a systematic review of published literature to gain a better understanding of the impact of advanced fellowships on surgical resident training and education.As fellowship opportunities rise, resident training may be adversely impacted.PubMed, MEDLINE, Scopus, BIOSIS, Web of Science, and a manual search of article bibliographies. Of the 139 citations identified through the initial electronic search and screened for possible inclusion, 23 articles were retained and accepted for this review. Data were extracted regarding surgical specialty, methodology, sample population, outcomes measured, and results.Eight studies retrospectively compared the eras before and after the introduction of a fellowship or trended data over time. Approximately half used data from a single institution, whereas the other half used some form of national data or survey. Only 3 studies used national case data. Fourteen studies looked at general surgery, 6 at obstetrics-gynecology, 2 at urology, and 1 at otolaryngology. Only one study concluded that fellowships have a generally positive impact on resident education, whereas 9 others found a negative impact. The remaining 13 studies found mixed results (n = 6) or minimal to no impact (n = 7).The overall impact of advanced surgical fellowships on surgical resident education and training remains unclear, as most studies rely on limited data of questionable generalizability. A careful study of the national database of surgery resident case logs is essential to better understand how early surgical specialization and fellowships will impact the future of general surgery education.

    View details for DOI 10.1097/SLA.0b013e318262edd5

    View details for Web of Science ID 000312261000012

    View details for PubMedID 22968071

  • Bilateral Adrenal Medullary Hyperplasia Associated With an SDHB Mutation JOURNAL OF CLINICAL ONCOLOGY Grogan, R. H., Pacak, K., Pasche, L., Huynh, T. T., Greco, R. S. 2011; 29 (8): E200-E202

    View details for DOI 10.1200/JCO.2010.32.2156

    View details for Web of Science ID 000288161000006

    View details for PubMedID 21172883

  • Massive Extra-adrenal Retroperitoneal Paraganglioma: Pre-operative Embolization and Resection DIGESTIVE DISEASES AND SCIENCES Rosing, J. H., Jeffrey, R. B., Longacre, T. A., Greco, R. S. 2009; 54 (8): 1621-1624

    View details for DOI 10.1007/s10620-009-0804-6

    View details for Web of Science ID 000267485400002

    View details for PubMedID 19408117

  • Fabrication of multi-layered biodegradable drug delivery device based on micro-structuring of PLGA polymers BIOMEDICAL MICRODEVICES Ryu, W. H., Vyakarnam, M., Greco, R. S., Prinz, F. B., Fasching, R. J. 2007; 9 (6): 845-853


    A programmable and biodegradable drug delivery device is desirable when a drug needs to be administered locally. While most local drug delivery devices made of biodegradable polymers relied on the degradation of the polymers, the degradation-based release control is often limited by the property of the polymers. Thus, we propose micro-geometry as an alternative measure of controlling drug release. The proposed devices consist of three functional layers: diffusion control layer via micro-orifices, diffusion layer, and drug reservoir layers. A micro-fabrication technology was used to shape an array of micro-orifices and micro-cavities in 85/15PLGA layers. A thin layer of fast degrading 50/50PLGA was placed as the diffusion layer between the 85/15PLGA layers to prevent any burst-type release. To modulate the release of the devices, the dimension and location of the micro-orifices were varied and the responding in vitro release response of tetracycline was monitored over 2 weeks. The release response to the different micro-geometry was prominent and further analyzed by FEM simulation. Comparison of the experiments to the simulated results identified that the variation of micro-geometry influenced also the volume-dependent degradation rate and induced the osmotic pressure.

    View details for DOI 10.1007/s10544-007-9097-8

    View details for Web of Science ID 000250462200009

    View details for PubMedID 17577671

  • The construction of three-dimensional micro-fluidic scaffolds of biodegradable polymers by solvent vapor based bonding of micro-molded layers BIOMATERIALS Ryu, W., Min, S. W., Hammerick, K. E., Vyakarnam, M., Greco, R. S., Prinz, F. B., Fasching, R. J. 2007; 28 (6): 1174-1184


    It is increasingly important to control cell growth into and within artificial scaffolds. Tissues such as skin, blood vessels, and cartilage have multi-layer structures with different cells in each layer. With the aid of micro-fabrication technology, a novel scaffolding method for biodegradable polymers such as polylactic acid (PLA), polyglycolic acid (PGA), and the copolymers poly(lactide-co-glycolide)(PLGA), was developed to construct three-dimensional multi-layer micro-fluidic tissue scaffolds. The method emphasizes micro-fluidic interconnections between layers within the scaffolds and maintenance of high-resolution geometries during the bonding process for the creation of multi-layered scaffolds. Micro-holes (10-100 microm), micro-channels, and micro-cavities were all created by micro-molding. Solvent-vapor based bonding of micro-molded layers preserved 20 microm sized structures. Sample scaffolds were constructed for purposes such as channel-directed cell growth and size-based cell sorting. Further extension of these techniques to create a micro-vascular network within or between layers is possible. Culturing of human coronary artery endothelial cells (HCAECs) on the sample scaffolds demonstrated the biocompatibility of the developed process and the strong influence of high-resolution micro-geometries on HCAEC growth.

    View details for DOI 10.1016/j.biomaterials.2006.11.002

    View details for Web of Science ID 000243219000028

    View details for PubMedID 17126395

  • Microfabrication technology of biodegradable polymers for interconnecting microstructures JOURNAL OF MICROELECTROMECHANICAL SYSTEMS Ryu, W., Fasching, R. J., Vyakarnam, M., Greco, R. S., Prinz, F. B. 2006; 15 (6): 1457-1465
  • Micro Fabrication Technology for Biodegradable Polymers for Interconnecting Microstructures Ryu WonHyoung, Fasching R, Vyakarnam M, Prinz F, Greco R S 2006
  • Nanotechnology Applied to Biological Systems Greco RS. 2004
  • Immunohistochemical profile of the sodium/iodide symporter in thyroid, breast, and other carcinomas using high density tissue microarrays and conventional sections JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Wapnir, I. L., van de Rijn, M., Nowels, K., Amenta, P. S., Walton, K., Montgomery, K., Greco, R. S., Dohan, O., Carrasco, N. 2003; 88 (4): 1880-1888


    Extrathyroidal cancers could potentially be targeted with (131)I, if the Na(+)/I(-) symporter (NIS) were functional. Using immunohistochemical methods we probed 1278 human samples with anti-NIS antibody, including 253 thyroid and 169 breast conventional whole tissue sections (CWTS). Four high density tissue microarrays containing a wide variety of breast lesions, normal tissues, and carcinoma cores were tested. The results of the normal microarray were corroborated in 50 CWTS. Nineteen of 34 normal tissues, including bladder, colon, endometrium, kidney, prostate, and pancreas, expressed NIS. Nineteen of 25 carcinomas demonstrated NIS immunopositivity; 55.7% of 479 carcinoma microarray cores expressed NIS, including prostate (74%), ovary (73%), lung (65%), colon (62.6%), and endometrium (56%). NIS protein was present in 75% benign thyroid lesions, 73% thyroid cancers, 30% normal-appearing, peritumoral breasts, 88% ductal carcinomas in situ, and 76% invasive breast carcinoma CWTS. Comparatively, breast microarray cores had lower immunoreactivity. Plasma membrane immunopositivity was confirmed in thyrocytes, salivary ductal, gastric mucosa, and lactating mammary cells. In other tissues, immunoreactivity was predominantly intracellular, particularly in malignant lesions. Thus, NIS is present in many normal epithelial tissues and is predominantly expressed intracellularly in many carcinomas. Elucidating the regulatory mechanisms that render NIS functional in extrathyroidal carcinomas may make (131)I therapy feasible.

    View details for DOI 10.1210/jc.2002-021544

    View details for Web of Science ID 000182211000072

    View details for PubMedID 12679487

  • Neutrophil survival on biomaterials is determined by surface topography. J Vasc Surg. Chang S, Popowich Y, Greco RS, Haimovich B. 2003; 37 (5): 1082-90
  • PMN exposure to a quantified bacterial load leads to a rapid, non-apoptotic cell death. Surg Forum Popowich Y, Greco RS, Haimovich B. 2001; 87 (LII): 344-346
  • Dacron and ePTFE-associated neutrophil death is linked to surface to surface topography and involves activation of SRC and PYK tyrosine kinases. Surg Forum Chang SS, Haimovich B, Greco RS. 2000; 86 (LI): 404-407
  • The cardboard box JAMA Greco RS. 2000; 284 (5): 534
  • Neutrophil Adhesion to vascular prosthetic surfaces triggers non-apoptotic cell death. Ann Surg Nadzam G, De La Cruz C, Greco RS, Haimovich B. 2000; 231 (4): 587-599