SURGERY DEPARTMENTvecchiosito.istitutotumori.mi.it/istituto/documenti... · Vincenzo Pruiti ADMINISTRATIVE PERSONNEL Roberta Aceto NURSES Katia PMasala (head of nurses), Rosalia Aloe,

The Department of Surgery is composed of 10 surgical divisions and threedepartmental units, organized for homogeneity of performance, with 240 inpa-tient beds and 14 outpatient beds. The Department treats oncologicaldiseases that affect all areas of the body except for the brain, providing elec-tive and emergency surgical activity, in ordinary inpatient and day hospitalregimens, and specialistic oupatient activity for diagnosis and follow-up. Rou-tine clinical activity ensures a high standard of care for all surgically-treatedpatients, providing conservative surgery (organ/function preserving or mini-mally invasive) for early stage disease and combined treatment modalities foradvanced disease.

UNITS

GASTROINTESTINAL, HEPATOPANCREATOBILIARY SURGERY, AND

LIVER TRANSPLANTATIONVincenzo Mazzaferro

COLORECTAL SURGERYErmanno Leo

BREAST SURGERYRoberto Agresti

MELANOMA AND SARCOMAMario Santinami

DIAGNOSTIC ENDOSCOPY ANDENDOSCOPIC SURGERY

Emanuele Meroni

OTOLARYNGOLOGY SURGERYGabriele Scaramellini

GYNECOLOGIC ONCOLOGYFrancesco Raspagliesi

THORACIC SURGERYUgo Pastorino

PLASTIC AND RECONSTRUCTIVESURGERY

Maurizio B. Nava

UROLOGIC SURGERYRoberto Salvioni

PEDIATRIC SURGERYLuigi Piva

LASER THERAPYAnna Colombetti

DAY SURGERYAldo Bono

DIRECTOR OF DEPARTMENT

Ugo Pastorino+39 02 2390 2906

[email protected]

SURGERY DEPARTMENT

91 Scientific Report 2011

gastrointestinal, hepatopancreatobiliary surgery, and liver transplantation

HEADVincenzo Mazzaferro, MD

CLINICAL RESEARCH STAFFCarlo Battiston MD, staff surgeon; Sherrie Bhoori MD, hepato-gastoenterologist; Jorgelina C. Coppa MD, staff surgeon;Christian Cotsoglou MD, staff surgeon; Alessandro GerminiMD, staff surgeon; Vincenzo Mazzaferro MD, Head of Unit;Andrea Pulvirenti MD, staff surgeon; Enrico Regalia MD, staffsurgeon; Raffaele Romito MD, staff surgeon; Marcello SchiavoMD, staff surgeon; Carlo Ferruccio Sposito MD, consultantsurgeon

RESEARCH STAFFMaria Flores Reyes, MDSottotetti Elisa, MD

POSTDOCTORAL FELLOWSRaffaella Reati, MD

RESIDENTSMarco Angelo Bogini, MDDavide Citterio, MDCecilia Muscarà, MDMarco Nencioni, MDMatteo Origi, MD

ADMINISTRATIVE PERSONNELElisa Giavari and Francesco Roncacci, Unit Secretariat; DanielaGuarneri and Nela Zito, Scientific Secretariat;Simona G. Marchesi (Data manager)

NURSESPaola Serafin (head nurse), Adriana Blanco, Salvatore Bonafede,Annateresa Bugada, Milda Di Giacomo, Angela Mihaela Farcas,Stefania Fici, Francesca Maiorano, Giuseppe Marena, AntonellaMasiello, Monica Mitarotonda, Nadia Nicoletti, Patrizia PerottoGhi, Patrizia Rota, Rossina Sitta, Stefania Sperandio, CristinaStracquadaini, Patrizia Valentini, Luigi Zarrella

HEALTHCARE ASSISTANTSNicoletta Damiani, Rosa De Felice, Mariangela Lopriore,Annamaria Pancari, Angela Restaini, Enza Spina, Anna Vecchio

Activity is focused on improvement of the standard ofcare and clinical research of primary and secondarytumors affecting the liver, biliary system, pancreas, andgastrointestinal tract. In the particular setting of hepato-oncology, our unit can offer a complete panel of the mostup-to-date therapeutic options for liver cancer thatincludes liver transplantation, minimally-invasive and com-puter-assisted surgery, transarterial chemoembolizationand radioembolization, percutaneous and laparoscopictumor ablation, and use of molecular targeted therapies.A multidisciplinary approach is applied on a routine basisthanks to the presence of gastroenterologists in the unitand the close collaboration with the other specialties(radiology, oncology, nuclear medicine and other surgicalunits). The Liver Transplant Program is mainly focused ononcological indications and plays a leading role worldwidein defining the best indications for liver transplantation forcancer. More than 60% of patients are offered therapieswithin prospective clinical trials. Patient care and supportare at the highest standard with 800 admissions and 400major surgical procedures/year, among which treatmentof colorectal liver metastases and hepatocarcinoma rep-resent the leading group. A permanent laboratory staff at the INT direct expres-sion of the hepatobiliary clinical Unit will complete theprogram of the Consortium on Translational Research on

Liver Tumors already active in the two sister labs atBarcelona and New York. As a part of the Institutionalresearch at the INT, the liver tumor translational lab willhave access to all technological platforms and technicaldevices described in the Shared Research Resorces.In addition, clinical technologies are routinely used in themanagement of patients. The pre-operative assessmentuses the Myrian software that allows 3D reconstructionof the vascular anatomy of the patient and calculation ofthe volume of the remnant liver after intervention. Weuse the LIMON system to perform the indocyanine greenretention test to calculate liver function. Laparoscopicprocedures are performed in a dedicated operative roomin which all devices are integrated and can be controlledby the surgeon through a touch screen. All technologiesare at the highest level: ultrasonic and radio-frequencydissectors, bipolar vessel sealers, radiofrequency andmicrowave needles for tumor ablation, high definitionvideo cameras, and monitors. We perform ultrasound-guided surgery and ablation with the newest ultrasoundmachines with or without contrast enhancement, usingintraoperative and laparoscopic probes. The unit is a pio-neer in computer-assisted liver surgery. This is performedusing an ultrasound navigation system that allows localiza-tion of tumors deep in the liver that would not otherwisebe visible through conventional ultrasound.

RELEVANT NOTES

Collaborations

Barcelona Clinic Liver Cancer Group,Barcelona, Spain; Liver Unit of the Mt. SinaiSchool of Medicine , New York USA;Harvard Broad and Dana-Farber Institute,Boston, USA; ENETS Program; Universityof Geneva, Switzerland; University ofMilan, Gastroenterology and Surgery;Nord-Italia Transplant (NITp), Milan

Publications

Villanueva A, Hoshida Y, Battiston C, TovarV, Sia D, Alsinet C, Cornella H, Liberzon A,Kobayashi M, Kumada H, Thung SN, Bruix J,Newell P, April C, Fan JB, Roayaie S,Mazzaferro V, Schwartz ME, Llovet JM.Combining clinical, pathology, and geneexpression data to predict recurrence ofhepatocellular carcinoma.Gastroenterology. 2011; 140(5): 1501-12.

Toffanin S, Hoshida Y, Lachenmayer A,Villanueva A, Cabellos L, Minguez B, SavicR, Ward SC, Thung S, Chiang DY, Alsinet C,Tovar V, Roayaie S, Schwartz M, Bruix J,Waxman S, Friedman S, Golub T,Mazzaferro V, Llovet JM. MicroRNA-basedclassification of hepatocellular carcinomaand oncogenic role of miR-517a.

Gastroenterology. 2011; 140(5): 1618-28.

Mazzaferro V, Majno P. Principles for thebest multidisciplinary meetings. LancetOncology. 2011; 12(4): 323-5.

Contributions

II Level Master on Organ TransplantationMedicine, University of Milan-Bicocca

Dr. Mazzaferro: Professor of Surgery(contract) and Director of Training Centerfor the University of Milan (post-graduateresidency program) and the ItalianAssociation of Hospital Surgeons (ScuolaNazionale di Chirurgia Epaticadell’Associazione Chirurghi OspedalieriItaliani)

Dr. Mazzaferro: Scientific Director ofRadioembolization Courses, Milan, Italy

Dr. Mazzaferro: Associate Editor of Journalof Hepatology and member of theEditorial Board of Hepatology, LancetOncology, and Liver Transplantation

Dr. Mazzaferro: Expert for EASL(European Association for the Study of theLiver): EASL-EORTC Clinical Guidelines ofHepatocellular Carcinoma

Dr. Mazzaferro: Head GEP-NET Center ofexcellence

92Surgery Department


colorectal surgery

HEAD Ermanno Leo, MD

CLINICAL RESEARCH STAFF Luigi Battaglia, MD Filiberto Belli, MD Giuliano Bonfanti, MD Alessandro Cesa Bianchi, MD Francesco Gallino, MD Marco Vitellaro, MD

RESIDENTS Michele Droz Dit Busset Marcello Guaglio Gaia Pietropaolo Vincenzo Pruiti

ADMINISTRATIVE PERSONNEL Roberta Aceto

NURSES Katia Masala (head of nurses), Rosalia Aloe,Maria Paola Augello, Placida Battaglia, FabianaBettoni, Lucia Caracciolo, Rut Cittadin,Angela Colamonaco, Alonso Manuel,Magdalena Marica Melis, Antonio Micello,Vanessa Neri, Maria Palma, Riccardo Vacca,Mirtha Ybazeta Ramos

HEALTHCARE ASSISTANTSIsabella Damasi, Nunzia Di Perna, FabioLizzano, Maria Petrosina

The Unit is specialized in surgery of cancers of the colonand rectum, and maintains an elevated surgical standardand quality similar to other major European referencecenters. In particular, over the years, the Unit has acquiredan extremely high expertise in the treatment of tumorsof the distal rectum, and has developed conservative

techniques that avoid extensive resection and definitivecolostomy. Another area of expertise is in treatment oflocal recurrences of rectal cancer : in selected patients,highly-specialized intervention can allow achievement ofradical excision even in previously recurrent tumors. Keywords: colon, rectum, cancer, surgery, colorectal cancer

RELEVANT NOTES

Publications

Battaglia L, Vannelli A, Belli F, Rampa M, Milione M,Gasparini P, Leo E. Giant condyloma acuminatum ofthe anorectum: successful radical surgery with analreconstruction. Tumori. 2011; 97(6): 805-7.

Contributions

Regional referent for guidelines for treatment ofrectal cancer.


breast surgery

HEAD Roberto Agresti, MD

CLINICAL RESEARCH STAFF Silvia Bohm, MD Alberto Rudy Conti, MD Cristina Ferraris, MD Massimiliano Gennaro, MD Maria Ilaria Grosso, MD Gabriele Martelli, MD Cristina Pellitteri, MD Domenico Piromalli, MD

FELLOWS Mario Rampa, MD

POSTDOCTORAL FELLOWS Ilaria Maugeri, MD

ADMINISTRATIVE PERSONNEL Angela Allegri

NURSES Irene Alessandrini, Giovanni Cavaliere,Myria Paola Conti, Stefano Licata, BrunaNuscis, Maria Carla Puddu, MicheleRossello, Gelsomina Sasso, FrancescoAntonio Spagnolo, Liliane Venafra

HEALTHCARE ASSISTANTSMaria Caterina Fadda, Luigi Magnifico,Caterina Pianu

The clinical activity of the Unit includes all aspects ofbreast cancer treatment: diagnosis, primary and adjuvanttherapy, and follow up. Treatment is performed by multi-disciplinary teams involving several other Units andDepartments. The results from a randomized clinical trialcomparing axillary dissection with observation in patientsaged >65 years with T1N0 breast cancer has beenaccepted in Annals of Surgery. Moreover, we have investi-gated in a consecutive series of elderly breast cancerpatients without palpable axillary nodes whether biologi-cal markers may predict axillary relapse and breast cancermortality. The paper is under review. Another randomizedclinical trial aiming at the development of integrated ther-apeutic strategies to reduce surgical morbidity in thetreatment of T1N0 breast cancer is ready for publication.In a joint study with the MRI Unit, we have evaluated theability of MRI to show the extent and location of thetumor in a breast surgical specimen by ex vivo MRI. The

paper is under review. A pilot study is in progress com-paring FDG-PET with sentinel lymph node biopsy forstaging of regional lymph nodes, followed a previousexperience in the use of PET in preoperative evaluationof axillary lymph nodes. Enhanced understanding of thepathogenesis of breast cancer coupled with growing inter-est in improved esthetic results led to investigation ofskin-sparing and nipple-sparing mastectomy as a potentialmodification to conventional mastectomy. In the last threeyears, we performed over 400 NAC sparing mastectomies.In cooperation with the Medical Genetics Unit, anapproach tailored for women at high genetic risk hasbeen developed. During genetic counseling, genetic riskestimation is performed to allow a personalized programincluding available preventive options and treatments. Fur-thermore, patient risk stratification allows classification ofpatients and tumors.Keywords: breast cancer, surgical treatment, axillary management

RELEVANT NOTES

Publications

Martelli G, Miceli R, Daidone MG, Vetrella G,Cerrotta AM, Piromalli D, Agresti R. Axillarydissection versus no axillary dissection in elderlypatients with breast cancer and no palpable axillarynodes: results after 15 years of follow up. Ann SurgOncol 2011; 18: 125-33.

Secreto G, Meneghini E, Venturelli E, Cogliati P,Agresti R, Ferraris C, Gion M, Zancan M, Fabricio

AS, Berrino F, Cavalleri A, Micheli A. Circulating sexhormones and tumor characteristics inpostmenopausal breast cancer patients. A cross-sectional study. Int J biol Markers. 2011; 26: 241-6.

Contributions

Roberto Agresti: editorial board of The ScientificWorld Journal


melanoma and sarcoma

HEAD Mario Santinami, MD

CLINICAL RESEARCH STAFF Melanoma Andrea Maurichi, MDDaniele Moglia, MD Roberto Patuzzo, MDRoberta Ruggeri, MDSurgery of Sarcoma Alessandro Gronchi, MD(Director) Dario Baratti, MDChiara Colombo, MDMarcello Deraco, MDMarco Fiore, MD

RESEARCH STAFF Federica Crippa, MDShigeki Kusamura, MDElena Tolomio, MD

RESIDENTS Giulia Baffa, MDIlaria Mattavelli, MD

Carlotta Tinti, MD Stefano Radaelli, MD

ADMINISTRATIVE PERSONNEL Antonella Vescera

CLINICAL TRIALSCOORDINATOR Annabella Di Florio

HEALTHCARE ASSISTANTS Giovanna Lomartire (Head,responsible quality Dept. ofSurgery), Nicola Abatangelo,Annamaria Biondo, SoniaCappellini, Annarita Carluccio,Alessio Cremonesi, NelloCuratolo, Loridana Marino,Elda Neira, Erica Panigada,Giusy Pede, Esther ReinosoCrespo, Claudia Sonzogni,Monica Ullio, Addolorata Volpe,Roberta Allenza, AntonellaComasicchio, Floarea Dorca,Silvana Mirante

Melanoma During 2011, more than 550 melanomapatients were treated by major surgery. More than15,000 patients were seen in the outpatient clinic and1000 were treated by minor surgery; a unit database,containing more than 4000 patients in the last 10 years,has been managed. Sarcoma Our Institution is a referral center for soft tissuesarcomas of the extremities and trunk, as well asretroperitoneal sarcomas, GIST, and axial bone sarcomas.In 2011, we carried out 342 major operations for newpatients and 24 operations for patients already treated atour institution in the past and presenting for a loco-regional recurrence. We saw 850 new patients inconsultation and performed routine follow-up visit forover 3000 cases. We also chaired the surgical section ofthe Italian Network on Rare Tumors, performing weeklysecond opinion through the network. Peritoneal CancersThe clinical and scientific activities areoriented to the study and treatment of primary and sec-

ondary peritoneal tumors, and primarily for two rare dis-eases: malignant peritoneal mesothelioma (MPM) andpseudomyxoma peritonei (PMP). An additional field ofinterest is represented by peritoneal carcinomatosis.These disease entities are clinically managed inaccordance with our institutional and ROL diagnostic andtherapeutic guidelines, within a multidisciplinary clinicalteam involving the surgeons of our unit with medicaloncologists, pathologists, and experimental oncologists.Considering the resources available, only a limited groupof patients with peritoneal cancer and selected to receivecombined treatment, are currently treated at our institu-tion. Most patients are referred to other centers wherethe procedure is available in accordance with the logisticrequirements of the patients themselves. In the periodunder review, a total of 23 interventions of CRS andHIPEC were performed at our institution for MPM(n=12), PMP (n=10), or other peritoneal carcinomatosis(n=1).Keywords: melanoma, sarcoma, peritoneal cancers

RELEVANT NOTES

Publications

Gronchi A, Miceli R, Colombo C, Collini P,Stacchiotti S, Olmi P, Mariani L, Bertulli R, Fiore M,Casali PG. Primary Extremity Soft Tissue Sarcoma:outcome improvement over time at a singleinstitution. Ann Oncol. 2011; 22(7): 1675-81.

Gronchi A and Pollock RE. Surgery inretroperitoneal soft tissue sarcoma: a call for aconsensus between Europe and North America.Ann Surg Oncol. 2011; 18: 2107-10.

Deraco M, Elias D, Glehen O, Helms W, SugarbakerP.H. Verwaal V. Peritoneal Surface Malignancy

Cancer Principles and Practice of Oncology. Ed. IX2011 Editors: De Vita, Hellman and Rosemberg.

Yan TD, Deraco M, Elias D, Glehen O, Levine EA,Moran BJ, Morris DL, Chua TC, Piso P, SugarbakerPH; Peritoneal Surface Oncology Group. A noveltumor-node-metastasis (TNM) staging system ofdiffuse malignant peritoneal mesothelioma usingoutcome analysis of a multi-institutional database.Cancer. 2011; 117(9): 1855-63.

Contributions

Melanoma Deputy President of SICO (SocietàItaliana Chirurgia Oncologica)

Editorial board and reviewer: Annals of Surgery,Dermatology Research and Practice, EuropeanJournal of Dermatology, European Journal Surgical

Oncology, Journal Investigative Dermatology,Oncology, Surgical Oncology, World Journal ofClinical Pediatrics, World Journal of Dermatology,World Journal Surgical Oncology, Tumori, Sarcoma

Member of: Sarcoma Task Force European Societyfor Medical Oncology (ESMO); Connective TissueOncology Society board of directors (CTOS);International Committee of the Society of SurgicalOncology (SSO)

Secretary of EORTC Soft Tissue and BoneSarcoma Group; Chairman of Italian SarcomaGroup (ISG) Soft Tissue Sarcoma committee;Associate Editor of Sarcoma Journal; SarcomaSection Editor for Annals of Surgical Oncology


diagnostic endoscopy and endoscopic surgery

HEAD Emanuele Meroni, MD

CLINICAL RESEARCH STAFF Giovanni Ballardini, MD Giuseppe Calarco, MD Gianfranco Di Felice, MD Massimo Falsitta, MD Andrea Mancini, MD

NURSES Vittorio Mauro (head nurse); FrancescoBottani, Raffaele Calò, Roberto FioccoDaniele Lo Curcio, Francesca Mannai,Giovanni Sammartino, Raffaele Quagliolo

TECHNICIANS Silvia Cara, Rosanna Loi, Salvatore Morfeo

ADMINISTRATIVE PERSONNEL Concetta Di Quattro Annamaria Mercuri

The activities of this multidisciplinary endoscopy Unitinclude diagnostic and therapeutic procedures of the gas-trointestinal, biliopancreatic, respiratory, and urinarytracts. The Unit is particularly committed to cancer pre-vention and early cancer diagnosis and treatment. Aspecial effort is dedicated to the Regional ColorectalCancer Screening Program as well as to endoscopic sur-veillance of patients affected with familial adenomatouspolyposis (FAP) or Lynch syndrome. Detection and stag-ing of early cancer is potentiated by the use of advanceddiagnostic technologies, such as wireless capsuleendoscopy (WCE) for the study of small intestine andendoscopic ultrasonography (EUS) for the study of gas-trointestinal tract and biliopancreatic malignancies. The

Unit is a core partner of the institutional GastroEnteroPancratic NeuroEndocrine Tumors (GEP-NET) Center,according to ENETS guidelines. The Endoscopy Unit isalso a referral Center within the Lombardy Region forendoscopic treatment of a pre-cancerous esophagealcondition, such as Barrett’s esophagus, using endoscopicradiofrequency ablation (RFA). With regard to advancedcancers, endoscopic palliative therapy is routinelyprovided using argon plasma electrocoagulation, laserphotocoagulation, and stenting for tracheobronchial,esophageal, duodenal, and colorectal malignancies.Keywords: cancer prevention, endoscopic diagnosis, endoscopic

therapy

RELEVANT NOTES

Collaborations

A fruitful collaboration with the FondazioneIRCCS Istituto Neurologico Carlo Besta is ongoingfor treatment of symptoms related to neurologicaldisorders (neurologic dysphagia, Parkinson’sdisease).

In 2011, collaboration started with PolitecnicoUniversity and Experimental OncologyDepartment of INT for preclinical research in thebiomedical field and for developing new diagnostictools.

Publications

Rotondano G, Bianco MA, Buffoli F, Gizzi G, TessariF, Cipolletta L on behalf of the FLIN investigators.The Cooperative Italian FLIN Study Group:prevalence and clinico-pathological features ofcolorectal laterally spreading tumors. Endoscopy.2011; 43: 856-61.

Libro Bianco della Gastroenterologia Italiana, 2011

Contributions

Dr Meroni is a member of the review board ofGastrointestinal Endoscopy and World Journal ofGastrointestinal Endoscopy.

In 2011, Dr Meroni also contributed to theGuidelines of the Regional Oncological Network.


HEAD Gabriele Scaramellini, MD

STAFF MEMBERS Roberto Bianchi, MD Sarah Colombo, MD Letizia M. C. Ferraro, MD Walter Fontanella, MD Paolo Formillo, MD Marco Guzzo, MD Tullio M. Ibba, MD, PhD Franco Mattavelli, MD Natalia R. E. Pizzi, MD Madia Pompilio, MD Stefano Riccio, MD

NURSES Giovanna V. Bello, Petronilla D’agostino,Angelo Di Caro, Giorgio Fumi, GiorgioInverni, Vincenzo Mandurino, Rosita Manna,Marta Marsella, Laura Ongari, DanielePezzera, Francesca Pisano, FedericaPrudenzano, Raffaella Repetto, MauraRimoldi, Maria Stefania Selva, Vincenzo Spanò(coordinator)

ADMINISTRATIVE PERSONNELSabrina Zazzera

TECHNICIANS Pablita Endaya, Vincenzo Marotta, Erick Papa,Immacolata Pedico

RELEVANT NOTES

Collaborations

Otolaryngology residency program, University ofMilan; Maxillo-facial residency program, Universityof Milan; “Miguel Hernandez de Elche” StateUniversity of Alicante (Spain): theoretical andhands-on head and neck dissection course foryoung surgeons

Fellowship: “management and treatment of headand neck tumors”

Publications

Guzzo M, Ferraro L, Rezzonico S, Ibba T, Bianchi R,Fontanella W, Scaramellini G. Open organ

preservation surgery of the larynx: Experience ofIstituto Nazionale Tumori of Milan. Head Neck.2011; 33: 673-8.

Sultan I, Rodriguez-Galindo C, Al-Sharabati S,Guzzo M, Casanova M, Ferrari A. Salivary glandcarcinomas in children and adolescents: apopulation-based study, with comparison to adultcases. Head Neck 2011; 33: 1476-81.

Contributions

ROL (rete oncologica lombarda) guidelines onadult head and neck cancers

The Division is highly specialized in the treatment ofbenign and malignant tumors of the head and neck area.In our Unit, state-of-the-art surgical treatment forpatients with head and neck tumors is guaranteed byexperts from across disciplines: otolaryngologists andmaxillofacial surgeons. Another key point is thyroid sur-gery, performed under the appointment of amultidisciplinary team including specialists in endocrinol-ogy and nuclear medicine. We are focused onquality-of-life issues such as retaining the patient’s abilityto speak and swallow, maintaining a normal appearance,and minimizing the functional outcome of surgical treat-ments. In this light, we are using tools forminimally-invasive surgery such as rigid endoscopy, newsources of light, and imaging for diagnosis and treatmentof cavity cancers. We have developed a multidisciplinaryteam including specialists in radiation oncology, medical

oncology, radiology, pathology, plastic and reconstructivesurgery, neurosurgery, dental and maxillofacial prosthetics,nutrition, and pain management. Weekly multidisciplinarymeetings ensure that each patient receives the adequateand customized treatment, as well as rehabilitation andprevention services, tailored to his/her needs. Preclinicalresearch is conducted in collaboration with medicaloncologists, pathologists, molecular biologists, andendocrinologists on prognostic features and moleculartargets of head and neck cancer. The office of outpatientoral precancerous lesions deals with diagnosis and con-servative treatment of oral lesions and our attention isfocused on HPV-related lesions and the cancerogeneticrole of this virus. Keywords: head neck cancer, organ preservation, multidisciplinary

approach

otolaryngology surgery

98

Maxillo-Facial Surgery (Gabriele Scaramellini, MD) In the Unit a state-of-the-art surgical treatment forpatients with head and neck tumors is guaranteed byexperts from across disciplines: head and neck surgeons,neurosurgeons, plastic surgeons, and dentists. This team ofspecialists treats patients with tumors of skull base,paranasal sinus, oral cavity, pharynx, salivary glands,melanomas, non-melanoma skin cancers, sarcomas of thesoft tissue and bone, and orbital and ocular adnexalmalignancies. Our surgical team works together withmedical oncologists and radiation oncologists to optimizefunctional outcome and provide the highest level of care.In particular, we have extensive experience in skull baseand paranasal sinus tumors and in complex reconstruc-tion of surgical defects of head and neck using freemicrovascular flaps, having the largest series in Italy forboth. In 2011, we focused on:

• the use of customized stereolithographic models inbone reconstruction; this method is used to obtain themost effective cosmetic and functional long-term results.• ozone-therapy followed by conservative surgery forthe treatment of BRONJ.• intraoperative rehabilitation after resection of themaxilla by using a prefabricated dental obturator.• development of endoscopic sinus surgery. During the year, we also carried out a study about thepossible role of polymorphisms in xenobiotic metaboliz-ing enzymes as a determinant for the degree ofsusceptibility to intestinal type adenocarcinomas (FRAC)and participated in the development of regional guide-lines for management.

RELEVANT NOTES

Collaborations

The Unit actively cooperates with theNeurosurgery Unit of the Fondazione IRCCSIstituto Neurologico C. Besta of Milan and theMaxillo-Facial Surgery Unit of the S. Anna Hospitalof Como.

Publications

Cantu G, Solero CL, Miceli R, Mattana F, Riccio S,Colombo S, Pompilio M, Lombardo G, Formillo P,Quattrone P. Anterior craniofacial resection formalignant paranasal tumors: a monoinstitutionalexperience of 366 cases. Head Neck. 2012; 34(1):78-87.

Licitra L, Perrone F, Tamborini E, Bertola L, GhirelliC, Negri T, Orsenigo M, Filipazzi P, Pastore E,Pompilio M, Bossi P, Locati LD, Cantu’ G,Scaramellini G, Pilotti S, Tagliabue E. Role of EGFRfamily receptors in proliferation of squamouscarcinoma cells induced by wound healing fluids ofhead and neck cancer patients. Ann Oncol. 2011;22(8): 1886-93.

Cantu G, Solero CL, Mariani L, Lo Vullo S, Riccio S,Colombo S, Pompilio M, Perrone F, Formillo P,Quattrone P. Intestinal type adenocarcinoma of theethmoid sinus in wood and leather workers: aretrospective study of 153 cases. Head Neck.2011; 33(4): 535-42.

Thyroid Surgery (Franco Mattavelli, MD)The Unit is focused on the diagnosis and treatment ofthyroid and parathyroid gland diseases in cooperationwith specialists in endocrinology, nuclear medicine, radiol-ogy, and pathology. Each patient is evaluated by amultidisciplinary team and receives appropriate surgicaland non-surgical treatment according to Institutionalguidelines. Special care is reserved to the treatment of

multiple endocrine neoplasia and pediatric malignanciesof the thyroid gland. Furthermore, the Unit is specializedin the surgical treatment of parathyroid glands disease,using the intraoperative parathormone monitoring. In2011, we studied the possible role of circulating miRNAas a prognostic factor in papillary thyroid cancer in coop-eration with Molecular Mechanisms Unit.

otolaryngology surgery

Surgery Department


gynecologic oncology

HEAD Francesco Raspagliesi, MD

CLINICAL RESEARCH STAFF Antonino Ditto, MD Rosanna Fontanelli, MD Barbara Grijuela, MD Francesco Hanozet, MD (1/10/2011 out) Marina Merola, MD Domenica Lo Russo, MD (1/11/2011 in)Eugenio Solima, MD Gianbattista Spatti, MD Bernardina Stefanon, MD Flavia Zanaboni, MD

FELLOWS Massimo Gabbanini, MD Valentina Guadalupi, MD Stefano Ramondino, MD

RESIDENT Fabio Martinelli, MD

ADMINISTRATIVE PERSONNEL Cinzia Marretta Rosella Zennoni

NURSES Lorenzina Greco, Eva Guitti, Marianela P.Maienza, Agnese Manganoni, MariannaMiranda, Rosanna P. Penasa, Maria R. T.Pichardo, Ylenia Ponti, Giuseppa M. Serravillo,Patrizia A. Valente, Viviana Villa, StefaniaLabori, Concetta Brugaletta, Claudio Oppido,Paolo Re, Rosita Bianco, Masha Kintaba

TECHNICIANS Michele Iannelli, Simona Tuiu, Rosa Farro,Laura Somma, Alessia Formicola, CeciliaMuzzupappa

The clinical activity of the Unit covers all aspects of gyne-cological surgery and medical oncology. The Unit dealsmainly with primary and secondary tumors of the femalegenital tract. The activities of staff members are dedicatedto clinical practice, research, and teaching (3 tumorboards weekly, international meetings; 3 surgical mastercourses yearly). Gynecologic Oncology is mainly focusedon: first entry gynecological oncological evaluation; familialcancer ; abnormal pap-test and 1st and 2nd levelcolposcopy; HPV multidisciplinary office; 1st and 2nd levelUS; hysteroscopy; follow-up. All surgical and medical treat-ments are coordinated on a weekly basis meeting by amultidisciplinary team involving surgeons, medical oncolo-gists, pathologists, and radiotherapists. The researchactivity of the group concerns clinical studies from basicscience to clinical research. In collaboration with theExperimental Oncology Department and Molecular Med-icine, we carried out several studies on gene expression,folate receptor levels, and apoptosis in ovarian carcinoma.Studies on the detection of stem cells in normal ovaries

and ovarian cancer to preserve the endocrine potential inovarian cancer patients by selecting new drugs againstthese cells are ongoing. Clinical research aimed to evalu-ate the efficacy of chemotherapeutic agents in ovariancancer, cervical cancer, and uterine sarcoma. Active collab-oration in international and national multicentercontrolled clinical studies in both medical and surgicalprotocols is ongoing. In the management of gynecologicalcancer, our standards of care reproduce internationalguidelines. To improve the prognosis of early stage cancer,several studies are ongoing on the efficacy and safety oflaparoscopic techniques in gynecological oncology. Weextended the concept of mini-invasiveness to laparotomyto reduce the complications of radical hysterectomy. As aresult of our commitment in gynecological oncology, theperi-operative morbidity, mortality and postoperativehospital stay in our Unit are excellent compared to theinternational standards for gynecologic surgery. Keywords: gynecological surgery, chemotherapy, research

RELEVANT NOTES

Collaborations

MITO collaborative group; MANGO collaborativegroup; ESGO group Università degli Studi andPolitecnico, Milan; Department of GynecologicalOncology, University of Turin, Mauriziano Hospital

Publications

Cibula D, Abu-Rustum NR, Benedetti-Panici P,Köhler C, Raspagliesi F, Querleu D, Morrow CP.New classification system of radical hysterectomy:emphasis on a three-dimensional anatomic

template for parametrial resection. Gynecol Oncol.2011; 122(2): 264-8.

Ditto A, Martinelli F, Mattana F, Reato C, Solima E,Carcangiu M, Haeusler E, Mariani L, Raspagliesi F.Class III nerve-sparing radical hysterectomy versusstandard class III radical hysterectomy: anobservational study. Ann Surg Oncol. 2011; 18(12):3469-78.

Contributions

Three advanced forums in GynecologicalOncology with live surgery.


thoracic surgery

HEAD Ugo Pastorino, MD

CLINICAL RESEARCH STAFF Barbara Conti, MD Vincenzo Delledonne, MD Riccardo Giovannetti, MD Francesco Leo, MD Paolo Scanagatta, MD Luca D. Tavecchio, MD

FELLOWS Filippo Acerbis, MD Giuseppe Garofalo, MD Emilia Anna Polimeno, MD

PHD STUDENTS Leonardo Duranti, MD Simone Furia, MD

RESIDENTS Lara Girelli, MD Luca Turati, MD

NURSES Federica Pirovano, Brice Atiomeguim,Francesco Auletta, Marcella Bernardo, LauraDe Porras, Payà Yesica Del Rio Mendez,Margherita Fersurella, Fabrizio Lupo, Hilda A.Martinez, Daniele Marino, Maria L.Quitadamo, Anna M. Panareo, AntonioPantano, Antonella Prete, Antonino Proto,Simona Ugolini

TECHNICIANS Vincenzo Dellaquila, Nekpen Eguavoen,Antonietta G. Fantilli, Jose Salinas Montoya,Pamela K. Soto Fernandez

ADMINISTRATIVE PERSONNEL Tiziana Negri

RESEARCH STAFF Elena Bertocchi, Anna Maria Calanca, CaludioJacomelli, Carolina Ninni, Paola Suatoni

EXTERNAL COLLABORATORSElisa Bonati, Benedetta Finamore, BarbaraPuricelli, Valentina Rosato, Marta Rossi,Nicola Sverzellati

The mission of the Thoracic Surgery Unit is to providehigh-standard clinical care and scientific research by conti-nous improvement of processes and bed-side applicationof evidence-based medicine. Furthermore, traslationalresearch allows patients to benefit from advanced multi-modality strategies as soon as positive results areobtained from preclinical trials. Clinical activities cover allaspects of thoracic oncology, focusing on pulmonary,mediastinal, chest wall, and esophageal tumors. In themanagement of lung cancer, the mainstay of surgical treat-ment is maximal functional sparing. All patients undergomuscle-sparing thoracotomy, avoiding any muscular sec-tion. Lung-sparing procedures (bronchoplasty and/orangioplasty) are adopted to avoid the removal of theentire lung, when possible. A clinical randomized trial isongoing, searching for the best drainage strategy to limitpostoperative air leak (airINTrial). In the domain of sec-ondary lung tumors, the Thoracic Surgery Unitcooperates with different INT Units (mainly with Oncol-ogy, Pediatric Oncology and Sarcoma Units), performingstandard metastasectomy by innovative parenchyma-spar-

ing procedures (thulium laser + stem cells application).Extended resections are proposed when an acceptablepostoperative impairment of the quality of life can beexpected. Innovative techniques for tridimensional chestwall reconstruction have been developed (rib-like tech-nique), permitting appropriate reconstruction even incase of removal of an entire hemithorax. In mediastinalsurgery, superior vena cava (SVC) replacement isperformed by procedures not requiring SVC cross-clamp-ing, avoiding intraoperative hemodynamic instability.Pleuro-pneumonectomy is proposed in limited malignantmesothelioma, after induction chemotherapy. In moreadvanced disease, a trial will be started in 2012 to meas-ure the advantage of pleurectomy/decortication afterchemotherapy in terms of disease-free survival and qual-ity of life, compared to chemotherapy only (PASS trial).Esophageal surgery is performed in cooperation with dif-ferent Units (Otorhinolaryngology, Gastrointestinal-Pancreatic Liver Surgery, Endoscopy). Keywords: lung cancer, secondary lung tumors, thoracic oncology

RELEVANT NOTES

Collaborations

University of Milan, Thoracic Surgery and GeneralSurgery; University of Parma, Department ofClinical Science; Section of Radiology, Mario NegriInstitute, Milan; General Epidemiology IstitutoSuperiore di Sanità, Rome; San Raffaele, Milan;Humanitas Cancer Center, Milan; San Gerardo,Monza; University of Ohio US, Human CancerGenetics; University of Oxford UK, TumorPathology; International Agency for Research onCancer (IARC) Lyon FR, Infection and CancerEpidemiology

Publications

Girotti P, Leo F, Bravi F, Tavecchio L, Spano A,Cortinovis U, Nava M, Pastorino U. The “rib-like”technique for surgical treatment of sternal tumors:

lessons learned from 101 consecutive cases. AnnThorac Surg. 2011; 92(4): 1208-15.

Boeri M, Verri C, Conte D, Roz L, Modena P,Facchinetti F, Calabrò E, Croce CM, Pastorino U,Sozzi G. MicroRNA signatures in tissues andplasma predict development and prognosis ofcomputed tomography detected lung cancer. ProcNatl Acad Sci USA. 2011; 108(9): 3713-8.

Contributions

Patent: miRNA (BIOVITAS New York, US); EditorialBoard: Scientific reviewer for : Annals of Oncology,Annals of Thoracic Surgery, British Journal ofCancer, European Journal of Cancer, InternationalJournal of Cancer, Lung Cancer, Respiration, Thorax,Tumori, European Journal of Cardio-ThoracicSurgery. Associate Editor of the Journal of theNational Cancer Institute.


plastic and reconstructive surgery

HEADMaurizio B. Nava, MD

CLINICAL RESEARCH STAFF Umberto Cortinovis, MD Joseph Ottolenghi, MD Angela E. Pennati, MD Egidio Riggio, MD Andrea Spano, MD Novella Bruno, MD Manuela Forti, MD Pierfrancesco Cadenelli, MD

ADMINISTRATIVE PERSONNELLuisa Morandi

NURSESMaria Saracino (Head), Samantha F. Castelli,Cinzia Gentilini, Giusppe L’Abbate, MarisaLabò, Giovanna Melia, Caterina Pireddu,Irene Rossi, Raffaella Tupputi

TECHNICIANSRaffaella Cagnazzo, Nadia Casati, ProvvidenzaPeci, Nomi Ibazeta Ramos, Iolanda Panipucci

Reconstructive surgical procedures are related to demoli-tive breast and head and neck surgery, soft-tissue tumors,chest-wall surgery, and other types of aggressive onco-logic surgeries, as well as surgical treatment and repair ofskin cancer. Oncoplastic surgery represents a new stan-dard for reconstructive procedures after tumor excision.Plastic procedures related to breast cancer surgeryaccount for the main workload, and fat and implanthybrid breast reconstruction is planned and started con-currently with breast ablation. Fat cell transplantationallows implant-based reconstruction in some cases evenafter tissue damage by radiotherapy. In patients who arenot candidates for hybrid breast implant insertion, recon-struction is carried out with flaps. Both DIEP and free

flaps have been used for delayed or immediate breastreconstruction, after ablation of large soft tissue tumors,and in reconstruction after head and neck demolitions.Cohesive gel breast implants together with fat cell trans-plantation and microsurgery represent the higheststandard in reconstructive surgery. Fat tissue transplanta-tion using fat cells together with adipose-derived fat cellsand platelet-rich plasma allow us to regenerate damagedtissue. Oncoplastic surgery is actually the main activity ofthe unit and the core of its clinical and experimentalinvestigations.Keywords: plastic, oncoplastic-breast-skin-surgery, microsurgery, fat

cell transplantation

RELEVANT NOTES

Collaborations

We continue collaboration with the Departmentof Experimental Oncology and Molecular Medicineto evaluate the stem cell activity of injected fatcells.

Clinical Trials: EORTC, quality of life after Breastreconstruction, Suri-2 for breast reconstruction,Oncoplastic Workflow, to be validated with otherthree centers.

Publications

Folli S, Curcio A, Buggi F, Mingozzi M, Lelli D,Barbieri C, Asioli S, Nava MB, Falcini F. Improved

sub-areolar breast tissue removal in nipple-sparingmastectomy using hydrodissection. Breast. 2012;21(2): 190-3.

Nava MB, Pennati AE, Lozza L, Spano A, ZambettiM, Catanuto C. Outcome of different timings ofradiotherapy in implant-based breastreconstructions. Plast Reconstr Surg 2011; 128(2):353-9.

Contributions

In 2011, enrollment for clinical trials continued andnew clinical studies and experimental investigationshave been started. Collaboration with thePolitecnico University, Bioengineering Unit and theUniversity of Catania are still active.


urologic surgery

HEAD Roberto Salvioni, MD

CLINICAL RESEARCH STAFF Davide Biasoni, MD Mario A. Catanzaro, MD Angelo Milani, MD Nicola Nicolai, MD (Head, Testicular Cancer SurgeryUnit) Luigi Piva, MD (Head, Pediatric Surgery Unit)Silvia Stagni, MD Tullio Torelli, MD Andrea Necchi, MD (Faculty, Department ofMedical Oncology, Medical Oncology Unit 2)Patrizia Giannatempo, MD (Resident, Departmentof Medical Oncology, Medical Oncology Unit 2)Daniele Raggi, MD (Fellow, University of MilanSchool of Medicine)

NURSES Graziella Russo (Coordinator), Maria L.Cennamo, Anna M. Cercaci, Zino Ferro,Maria R. Leo, Francesca Marelli, GiovanniMazzilli, Lucia Mesiano, Arturo Monetta,Valentina Musarò, Giuseppa Napoli, VeronicaP. Rojas, Maria Silva, Annalisa Simone

ADMINISTRATIVE PERSONNEL Maria G. Bodini

TECHNICIANS Antonio Bonelli, Elena Cristiani, IsabellaVurchio, Olimpia Liberatore De La CruzVelesmoro Rocio Del Pilar

Urothelial cancer A study with pazopanib in relapsingurothelial cancer closed enrollment on July 2011. Veryimpressive responses were achieved. Concomitant trialswere planned, in particular a phase II study with the mon-oclonal antibody against the TGF-β receptor ALK1 wasaccepted for funding and support within the Rete Onco-logica Lombarda (ROL). Two other clinical trials areongoing: a clinical study with sorafenib and chemotherapyin the neoadjuvant setting and another randomized phaseII study of vinflunine and gemcitabine versus vinflunineand carboplatin as first-line therapy for cisplatin unfitpatients. Testicular cancerThe observational study on the qualityof life of patients undergoing retroperitoneal lymph-nodedissection (RPLND) as primary treatment for clinicalstage I disease continued enrolling during 2011. Prelimi-nary data show a general increase in FACT-G QoL scalescores from baseline to follow-up evaluations. Currentoptimization of laparoscopic RPLND shows that thetreatment has an acceptably low-morbidity, which canactually duplicate the historical oncologic results of openRPLND. A project aimed at re-evaluating the expression

of CD30 antigen in residual masses yielding viable cancerafter chemotherapy was started in late 2011. The objec-tive of this project was to establish the basis for a phase IIstudy with the immunoconjugated anti-CD30 monoclonalantibody (SGN-35, brentuximab) in the setting ofmetastatic and chemotherapy resistant disease. The phaseII study of tandem high-dose chemotherapy for relapsinggerm cell tumors continued enrolling throughout theyear. Penile cancer We pursued the multimodal project forclinically node-positive squamous cell carcinoma of thepenis aimed at evaluating the activity of neoadjuvant TPFchemotherapy followed by lymph-node dissection afterprimary tumor control that incorporates the use ofPET/CT for both staging and response evaluation prior tosurgery. Kidney cancer We extended the indications fornephron-sparing surgery. A new multidisciplinaryapproach with controlled intraoperative hypotension iscurrently under investigation in order to minimize renaldamage.Keywords: genitourinary cancer, multidisciplinary, mininvasive therapy

RELEVANT NOTES

Collaborations

International Consortium on RPLND InternationalGerm Cell Tumors Cooperative Group (G3)

Publications

Nicolai N, Colecchia M, Biasoni D, Catanzaro M,Stagni S, Torelli T, Necchi A, Piva L, Milani A, SalvioniR. Concordance and prediction ability of originaland reviewed vascular invasion and otherprognostic parameters of clinical stage Inonseminomatous germ cell testicular tumors afterretroperitoneal lymph node dissection. J Urol.2011; 186(4): 1298-302.

Necchi A, Nicolai N, Colecchia M, Catanzaro M,Torelli T, Piva L, Salvioni R. Proof of activity of anti-epidermal growth factor receptor-targeted therapyfor relapsed squamous cell carcinoma of the penis.J Clin Oncol. 2011; 29(22): e650-2.

Contributions

In late 2011, we actively participated at the 3rdEuropean Consensus Conference on Diagnosisand Treatment of Germ Cell Cancer aimed atupdating the European guidelines on the disease.Further collaborative projects on retrospectivecase-series within the international network areplanned. Currently, we are members ofInternational agencies involved in definition ofGuidelines in this field.


pediatric surgery

HEAD Luigi Piva, MD

The Unit collaborates with pediatric oncologists and pro-vides a high standard of treatment for the most frequentsolid - non central nervous system - tumors observed inchildren and adolescents. The role of surgery isestablished according to ongoing European treatmentprotocols. During 2011, the following surgical interven-tions were carried out. Wilms tumor: 15 surgeries onpatients enrolled in the TW 2003 AIEOP (AssociazioneItaliana Ematologia Oncologia Pediatrica) study, 10nephrectomies, 2 partial bilateral kidney excisions, and 4partial monolateral kidney excisions. Neuroblastoma: 5surgeries. Germ cell tumors/gynecological and andrologi-cal procedures: 2 orchiectomies, 2 surgeries on patientswith germ cell tumors, 2 partial scrotectomies, 2 testistranspositions, and 4 urological procedures. Soft tissuesarcomas and rare tumors: surgery on soft tissue sarco-

mas was performed in collaboration with the Melanomaand Sarcoma Unit: 17 soft tissue tumors and 5 cutaneouslesions. Cranio-maxillofacial tumors: in this type of tumor,surgeries are performed in cooperation with the ORLDivision: 1 total thyroidectomies, 2 hemi-thyroidectomies,1 parotidectomy, and 5 facial surgeries. Lung metastases:surgeries are performed in cooperation with ThoracicSurgery Unit: 7 metastasectomies and 6 patients under-went thoracotomy for different diseases. In collaborationwith the Colorectal Unit, 4 colectomies throughlaparoscopy were performed and 2 closing ileostomies.Breast procedures: 1 excision nodule and 2 partial breastexeresis. Finally, 14 surgical biopsies were necessary for 6sarcoma, 5 lymphoadenopathies, and 4 forganglioneuroma, renal tumor, and neuroblastoma. Keywords: renal tumors, pediatric sarcoma, multidisciplinary teams


laser therapy

HEAD Anna Colombetti, MD

CLINICAL RESEARCH STAFF Roberto Grillo, MDMario Z. Raso, MD

ADMINISTRATIVEAceto M. Rosaria

NURSEMaria Saracino (Coordinator), EmiliaD’Arrigo

HEALTHCARE ASSISTANTSDomenica Lo Prete

The Unit is dedicated to diseases where laser therapy isthe first or only treatment choice and features high qual-ity instrumentation including four lasers for a total of 20wavelengths. This allows both conservative and ablativetherapies. Selective photothermolysis laser treatment isperformed for keloids, pigmented and vascular lesions,and the laser ablation technique is used for mucosal andskin cancer lesions requiring histological evaluation. Treated lesions can be conveniently classified into 5groups:Tumor lesions: skin carcinomas, melanoma in-transitmetastases, cutaneous and mucosal localizations ofKaposi’s sarcoma, precancerous lesions such as actinic ker-atosisVascular lesions: flat-type congenital capillary angiodys-plasia, angiomas, and venous lymphatic angiodysplasia

Nevi: giant melanocytic nevi Traumatic and post-burn hypertrophic scars andkeloidsCutaneous localizations originating from complex syn-dromes, such as adenomas in tuberous sclerosis,angiodysplasias related to Sturge-Weber syndrome, neu-rofibroma, and cafe-au-lait spots in neurofibromatosis(with the INT serving as national referral center for thisdisease).Compared with previous years, an increasing rateof tumoral and vascular diseases and complex syndromeswas observed. During 2011, we performed 2000 treat-ments of laser therapy: 1400 of these procedures were inan ambulatory setting.Keywords: laser therapy, skin cancer, angiodysplasia

RELEVANT NOTES

Relevant technologies

The instrumentation of the Laser Unit includesfour lasers for a total of 20 wavelengths: modefiber, QS, pulsed light (IPL), and a CO2 laser forboth conservative and ablative therapies.

Collaborations

Diagnosis, follow-up, clinical and laser procedures,were performed with the Melanoma and SarcomaUnit for the treatment of melanoma in-transitmetastases. In collaboration with the Radiology

Unit, congenital and acquired vascular lesions arediagnosed and followed. The general clinicalmanagement of patients affected byneurofibromatosis is ensured by the MedicalGenetic Unit of the Fondazione IRCCS Policlinicoof Milan.

In collaboration with the Department ofAnesthesiology, 80 pediatric patients affected bygiant nevi, post-burn scars, hemangiomas, andcongenital vascular pathologies were treated withlaser procedures under general anesthesia.


day surgery

HEAD Aldo Bono, MD

ADMINISTRATIVE PERSONNEL Maria R. Bignamini, Anna Corella, LoredanaOrezzi

NURSESGiovanna R. Colaci, Mariangela Lena, Mara D.Luisoni, Pina P. Mele, Anna Picciallo, MarinaZocchi

HEALTHCARE ASSISTANTSGuglielmina Riccio, Franca Atzeni, AntonellaBordoni,

The Unit is devoted to surgical procedures performed inday hospital and ambulatory settings. The Unit includes 10beds, 2 operating rooms for various surgical activities, andone operating room for laser surgery. The clinical activitycovers many aspects of oncologic surgery, and in particu-lar includes the treatment of the different neoplasticlesions involving skin, soft tissues, and breast, as welllesions in gynecological, urological and head and neckareas. The activity involves physicians of the Departmentof Surgery, sometimes working in cooperation. During theyear 2011, about 4900 operations were performed. Ofthese, nearly 2800 were performed in a day hospital set-ting, whereas 2100 patients underwent outpatientsurgery. Nearly 4380 interventions were performedunder local anesthesia, while 520 were performed under

sedo-analgesia or general anesthesia. These procedureswere assisted by anesthesiologists from the IntensiveCare Unit. In addition to normal surgical activity, otherspecial procedures were performed such aselectrochemotherapy of secondary skin tumors (in col-laboration with the Melanoma and Sarcoma Unit) and fatinjection or lipostructure with the Coleman technique tolessen local skin and subcutaneous damage (in collabora-tion with the Plastic and Reconstructive Unit. Clinicalresearch activity is, at present, mainly performed in collab-oration with the Melanoma and Sarcoma Unit. The aim ofthis activity is to better define the initial clinical features ofearly melanoma to allow curative limited surgery.Keywords: day surgery, ambulatory surgery, early melanoma

RELEVANT NOTES

Publications

Bono A, Tolomio E, Carbone A, Moglia D, CrippaF, Tomatis S, Santinami M. Small nodularmelanoma: the beginning of a life-threateninglesion. A clinical study on 11 cases. Tumori. 2011;97: 35-38.

Contributions

Editorial Board of Tumori.

Reviewer activity of Archives of Dermatology,Melanoma Research, and Tumori.

Documents

SURGERY DEPARTMENTvecchiosito.istitutotumori.mi.it/istituto/documenti... · Vincenzo Pruiti ADMINISTRATIVE PERSONNEL Roberta Aceto NURSES Katia PMasala (head of nurses), Rosalia Aloe,