- Hepatobiliary Pancreatic and Colorectal Surgery Programme
The programme of Hepatobiliary Pancreatic and Colorectal Surgery is dedicated to the diagnosis and care of neoplasms of the liver, the bile ducts, the pancreas and the colon-rectum. The complexity of the tumours is tackled with a multidisciplinary and multimodal approach which guarantees all patients a path of personalized care, in keeping with the most modern and validated lines of therapy. Thanks to constant integrated collaboration in the form of multidisciplinary groups (GICs) with specialists from Oncology, Radiodiagnostics, Surgical Radiology, Endoscopy, Radiation Therapy, Nuclear Medicine and Anatomical Pathology, the most appropriate diagnostic-therapeutic path for each individual patient is identified, representing an essential starting point for the optimization of oncological results and for the chances of complete cure.
Surgery, the key treatment of many neoplasms of the gastroenteric tract, makes use of the most modern technologies at the Istituto di Candiolo allowing operators with a high level of competence and specialization to safely face complex surgical procedures offering a possibility of treatment to patients considered inoperable in peripheral or non-specialized facilities. The high competence in all areas of liver, pancreas and colorectal surgery allows the routine adoption of advanced surgical techniques such as complex ultrasound-guided liver resections sparing the parenchyma, two-stage hepatectomy or major hepatectomies after remodelling of liver volumes, the body-tail resections of the pancreas according to the "RAMPS" technique (Radical Antegrade Modular PancreatoSplenectomy), duodenocephalopancreasectomies with artery-first approach and the excision of the mesopancreas or the colic resections with CME (complete mesocolic excision ) and extended lymphadenectomies, TaTME (transanal Total Mesorectal Excision) for mid-low rectal tumors and TAMIS (TransAnal Minimally Invasive Surgery) for the removal of large polyps or some small rectal tumors.
In line with the evolution of modern surgery, for all surgery the approach of choice, where there are no clinical or technical contraindications, is minimally-invasive laparoscopy, making it possible to associate a magnified vision of anatomical detail with precision in surgical practice. The act of operating is then integrated into protocols of clinical-healthcare postoperative management (ERAS -Enhanced Recovery After Surgery), which ensure an optimal clinical recovery with early return to the patient's former social and work environments.
A multidisciplinary and multimodal vision reflects the modern approach to oncological disease and makes it possible to place the patient in a complex and highly specialized system which definess a pathway of optimal care according to the specific surgical, oncological, radiation therapy or surgical radiology competencies. Recent scientific publications have demonstrated how integration of surgery with the therapies of the Interdisciplinary Care Group (GIC) determine a significant improvement in results in terms of cure and quality of life. Each patient, moreover, is invited to take advantage of further support services (psycho-oncology service; social worker; connections with the local area for continuity of care and assistance).
The pathologies treated by the Programme of Hepatobiliary Pancreatic and Colorectal Surgery are:
- Tumours of the liver, both primary (hepatocarcinoma, intrahepatic cholangiocarcinoma, Focal Nodular Hyperplasia, hepatic adenoma, hepatic cystadenoma) and secondary (metastasis from neoplasms of different origin: colon-rectum, breast, kidney, neuroendocrine, pancreatic or intestinal tumours)
- Tumours of the extrahepatic bile ducts (Klatskin tumour, cancer of the gallbladder, cholangiocarcinoma of the distal bile duct)
- Tumours of the pancreas (adenocarcinomas, cystic tumours and neuroendocrine tumours)
- Tumours of the colon and of the rectum
- Tumours of the anal canal
- Surgery: Innovation for Better Care
Data from scientific literature show that resective surgery still represents the only potentially curative approach for most tumours of the liver and bile ducts. Similarly, in early stage pancreatic tumours, ie in the absence of distant metastases, as well as in those of the colon and rectum, surgical resection is the cornerstone of the pathway of care. However, the surgical technique and the experience of the operator represent a decisive factor for the possibility of healing. At the Istituto di Candiolo the surgeons adopt all the most modern and complex surgical techniques that, on the one hand guarantee a greater oncological radicality, and on the other allow for the removal of the tumour in patients who until a few years ago, or even today in non-specialized centres, were or are considered inoperable. Moreover, the innovation of the technique is aimed not only at eradicating the disease but also at preserving organ function (such as the saving of non-diseased liver or the preservation of the sphincters in rectal tumors) and integrity of the person. The minimally invasive approach, despite the greater complexity of execution by the operator, allows, in many cases, for the synergistic achievement of these objectives.
- Research: A Translational approach
Side by side with the Programme's clinical approach, dedicated to daily care of patients, we find the translational approach which takes material form in a continuous collaboration between clinical and preclinical research in order to identify the molecular alterations at the root of neoplastic transformation, of the capacity of the cancer cells to give rise to metastasis in other parts of the body, and of the mechanisms of resistence to chemotherapy. This collaboration, which, over the years, has made the Institute a leader in the field of research, represents the groundwork for the discovery of new drugs and personalized therapeutic strategies. Given the great importance of this research, all the patients operated on at the Institute are offered the opportunity to participate in translational research studies.
Surgical Team: Dario Ribero (Dr), Alfredo Mellano (Dr), Domenico Lo Conte (Dr), Anna Malpaga (Dr)
Surgical Endoscopy: Teresa Staiano (Dr.ssa), Giovanni Galatola (Dr), Cristiana Laudi (Dr.ssa)