Northern Sydney Central Coast Health (NSCCH)
Research Report Format 2010 For 2008/09
Upper Gastrointestinal Surgery Department
The Hepato-Biliary and Pancreatic Surgery Unit is part of the Department of Gastrointestinal Surgery at Royal North Shore Hospital. This is a tertiary referral unit for complex Hepatobiliary and Pancreatic cancers. In addition, members of the unit treat a large volume of benign pathology including acute general surgical conditions and trauma presentations.
The Hepato-Biliary and Pancreatic Surgery Unit undertakes a large volume of complex liver and pancreatic surgery. Our unit provides a tertiary and quarternary referral service for complex liver and pancreatic malignancies. We also have a particular interest in complex laparoscopic surgery and the management of difficult abdominal wall hernia problems.
Basic Laboratory-Based Research:
The Cancer Surgery and Metabolism Research Laboratory has two important directions; surgical metabolism and translational research relating to cancer biology. The head of the laboratory is Professor Ross Smith.
Studies involving the measurement of body composition have now been completed and the first of these has recently been published. This work has shown that patients undergoing major pancreatic surgery lose significant weight in the first 3 weeks after discharge even though they maintain their body composition during the hospital stay. Ali Aslani was awarded his PhD from this work and the quality of these results indicates the importance of the body composition equipment which is managed by the nuclear medicine Department at Royal North Shore Hospital.
Our group was involved in an international randomised study to examine the role of a new intravenous lipid emulsion called SMOF, a mixture of Soybean oil, Medium chain triglycerides, Olive oil and Fish oil. This study demonstrated safety for the long term use of SMOF and indicated improved liver function in these patients.
The unit has been active in proteomic research, looking at plasma protein expression particularly in pancreatic cancer. The aim has been to identify biomarkers of pancreatic cancer. The same technology has been used to assess cholangiocarcinoma as well as pancreatic cystic lesions. This has resulted in Chris Scarlett obtaining his PhD. This work has been further followed up Aiqun Xue, who has been looking at plasminogen-urokinase system and plasma apolipoproteins. The aim is to define the role of these proteins in the biology of pancreatic cancer. Aiqun’s work has established her as the senior research scientist in the CanSur laboratory. She was awarded a Cancer Council innovation grant to demonstrate the value of prognostic biomarkers in pancreatic cancer.
Ali Aslani was awarded his PhD based on this work. Our unit has also been collaborating with the Garvan institute on the pancreatic genome project. The aim of this project is to define the genetics of pancreatic cancer in the hope that this might lead to tailoring of therapy.
Cancer Surgery Research Foundation (CanSur)
CanSur was established in 1999 as a not-for profit charity. This has been an active foundation supporting the research in our unit. The inaugural board members included Professor Ross Smith and Dr Ray Hollings. In 2008, the board was expanded to include Mr Graham White, Mr John Burgess, and Dr Tom Hugh. The work of CanSur has been recognised by the NSW State government who generously supported the establishment of a network of surgeons to work together on the treatment of pancreatic cancer. This required the purchase of several -70°Crefrigeration units in a number of hospitals and the establishment of an internet facility to allow communication between these units.
Awards and Honours
NSW Cancer Institute 2008 Clinical Fellowship in HPB Surgery Dr Hugh Prof Smith A/Prof. Samra $163,000
Cancer Council Inovation Grant. Prof Smith and A Xue $87,000
In 2008 Dr Tom Hugh was appointed as an Executive member and Honorary Treasurer of the Australian and New Zealand Hepato-Pancreatico-Biliary Association (ANZHPBA)
Invited Lectures (excluding presentation of scientific papers)
Members of the unit have been invited to lecture both nationally and internationally. This reflects the research activity and high quality clinical work undertaken on the Northern campus
Dr Tom Hugh
- The investigation of the liver prior to major resection
Royal Australasian College of Surgeons, Annual Scientific Congress, Hong Kong 2008
- The anterior, inlay method for inguinal hernia repair
Biennial International Congress of the Australian Hernia Society 2008
- Portal Vein Embolisation (PVE) Is it necessary or beneficial?
ANZHPBA/AGITG Meeting, Coolum Qld. 2008
- Hepato-biliary and Pancreatic operative anatomy made easy
The inaugural ANZHPBA trainees meeting, Victor Harbour 2008
- Transcystic exploration of the CBD
Royal Australasian College of Surgeons, Annual Scientific Congress, Brisbane 2009
Visitors to the Department
Graham Coupland visiting lecturer for 2008
Professor Markus W Buchler
Professor of Surgery, University of Heidelberg, Germany
Visiting Professor 2008
Professor Giovanni Butturini
Professor of Surgery, Verona, Italy
Head of Department of GIT Surgery
Dr Thomas J Hugh MD FRACS
Key Clinical Departmental Staff
- Dr Jaswinder Samra D Phil FRCS(Eng & Ed) FRACS (HPB Surgeon)
- Dr Garett Smith MS FRACS (OG Surgeon)
- Dr Steven Leibman FRACS (OG Surgeon)
- Professor Ross Smith MD FRACS (Head of Basic Research)
- Dr Thomas J Hugh MD FRACS (HPB Surgeon)
HPB Surgery Dr Julian Choi
HPB Surgery Dr Raul Alvarado
Cancer Nurse Co-ordinator
Hepato-Biliary and Pancreatic Surgery: Nancy Consoli
Ms Vivienne Schiavone
- Dr AiQun Nielsen (Xue) MSc PhD
- Dr Steven Schlichtemeier
Hepato-Biliary & Pancreatic Surgery
The HPB unit is comprised of Dr Tom Hugh and Dr Jas Samra and their main focus is in the area of colorectal liver metastasis and pancreatic cancer. There are a number of ongoing clinical projects. Their main aim of their work has been to improve surgical resection techniques both in pancreatic and liver surgery. They are actively involved in studying the role of chemotherapy in liver damage as well as methods of inducing liver hypertrophy.
Chang DK, Merrett ND, Biankin AV Gill AJ, Samra JS, Smith RC, Hugh TJ. Improving outcomes for operable in pancreatic cancer: is access to safer surgery the problem? J Gastroenterol Hepatol 2008. 23(7) 1036-1045.
Gananadha S, Samra JS, Smith GS, Smith RC, Leibman S, Hugh TJ. Laparoscopic ePTFE mesh repair of incisional and ventral hernias.ANZ J Surg. 2008 Oct;78(10):907-13
Gill AJ, Johns AL, Eckstein R, Samra JS, Kaufman A, Chang DK, Merrett ND, Cosman, PH, Smith, RC, Biankin AV, Kench AG. Synoptic Reporting Improves Histopathological Assessment of Pancreatic Resection Specimens. Pathology, Accepted July 2008, for publication April 2009
Gillanders L, Angstmann K, Ball P, Chapman-Kiddell C, Hardy G, Hope J, Smith R, Strauss B, Russell D: AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand, Nutrition 24:10,998-1012,2008
Kong J. Gananadha S. Hugh TJ. Samra JS.Pancreatoduodenectomy: role of drain fluid analysis in the management of pancreatic fistula.ANZ Journal of Surgery. 78(4):240-4, 2008 Apr.
Kuo SCL, Gananadha S, Scarlett CJ, Gill A, Smith RC: Sporadic Pancreatic Polypeptide Secreting Tumors (PPomas) of the Pancreas. World J Surg, 32:1815-22, 2008.
Samra JS. Gananadha S. Hugh TJ. Surgical management of carcinoma of the head of pancreas: extended lymphadenectomy or modified en bloc resection?. [Review] [127 refs] ANZ Journal of Surgery. 78(4):228-36, 2008 Apr.
Schwartz TL, Sterkel BB, Myer-Rochopw GY, Gifford AJ, Samra JS, Sywak MS and Johnson FE. Accessory spleen masquerading as a pancreatic neoplasm. Am J Surg 2009. 197(6) 61-63.
Smith R. Pancreatic cancer – A clinical review. Medical Observer March 2009
Smith RC, Ledgard JP, Doig, G, Cheshire D. An automated nutrition screen for hospitalised patients: can it predict complication risk? Nutrition International,2009, 25,3,309-315
Xue A, Scarlett CJ, Jackson CJ, Allen BJ, Smith RC. Prognostic significance of growth factors and the urokinase-type plasminogen activator system in pancreatic ductal adenocarcinoma. Pancreas 2008; 36:160-7
Xue A, Xue M, Jackson C, Smith RC. Suppression of urokinase plasminogen activator receptor inhibits proliferation and migration of pancreatic adenocarcinoma cells via regulation of ERK/p38 signaling. Int J Biochem Cell Biol 2009 Aug;41(8-9):1731-8
Xue A. Scarlett CJ. Jackson CJ. Allen BJ. Smith RC. Prognostic significance of growth factors and the urokinase-type plasminogen activator system in pancreatic ductal adenocarcinoma Pancreas. 36(2):160-7, 2008 Mar