Report of the AUGIS Travel Fellowship Award 2015
Visit to IstitutoNazionaledeiTumori, Milan, Italy
Samuel J Ford, University Hospital Birmingham
I am a newly appointed consultant sarcoma surgeon at the University Hospital Birmingham with a CCT in upper GIresectional surgery. After completing the Royal College of Surgeons of England post-CCT Sarcoma Fellowship hosted by the University Hospital Birmingham, a further two months of intensive sarcoma training at theIstitutoNazionaledeiTumori, Milan was invaluable experience. I would like to thank the Executive Council of the Association of Upper Gastrointestinal Surgeons for the generous award of the AUGIS Travel Fellowship Award 2015 and I was honoured to represent the Association at one of the most prestigious cancer centres in Europe.
The IstitutoNazionaledeiTumori is internationally recognised as a centre of excellence for the management of GISTs and retroperitoneal sarcomas and is one of the World’s largest volume centres. Sarcoma surgery, including GISTs, is an unusual, specialised and complex branch of surgery. The publication of ‘Improving Outcomes Guidance for Sarcomas’ (NICE 2006) highlighted the importance of greater specialisation in the management of sarcoma patients ingeneral and specifically for the creation of supra-regional surgical units.
I was attached to Alessandro Gronchi, Chair of the institution’s Sarcoma Service and Vice Chair of the EORTC Soft Tissue and Bone Sarcoma Group. I was welcomed to the Unit and immediately integrated into all aspects of patient mangement and care. The frequency of multi-visceral retroperitoneal sarcoma resections gave me unrivalled experience in decision making during these complex indiviualised resections with particular regard to achieving adequate tumour control whilst maintaining function and avoidance of excessive morbidity. In particular, I learnt how to either preserve the pancreas or perform en-bloc resection and how to approach the posterior aspect of the tumour to ensure adequate muscle coverage. The Unit has a very active GIST surgery practice and is one of the leading Institutions defining the role of surgery in locally advanced and metastatic GIST.
The IstitutoNazionaledeiTumori is famed for its extensive database and during my stay I was able to write two original research papers on the role of vascular reconstructions in sarcoma surgery and the utility of perioperative chemotherapy and radiotherapy in extremity sarcoma. I was also honoured to be asked to write an invited review article detailing the role of surgery in advanced GIST for the European Journal of Cancer. During my stay the Institute hosted the Chordoma Foundation Scientific meeting where I was able to present data from the University Hospital Birmingham and the Royal Orthopaedic Hospital, Birmingham. I was invited to contribute to the Chordoma Foundation position statement on the management of recurrent Chordoma and the development of a trial randomising sacral chordoma patients to radical surgery or proton therapy.
There was of course time at the weekend to appreciate the medieval splendour of Milan and surrounding cities. I must also confess to returning several kilograms heavier having indulged in the Milanese hospitality. I am very grateful to all those at IstitutoNazionaledeiTumori for being so welcoming and putting up with my very limited Italian.
Alfa Romeo 1900 Super Sprint 1954 at the MuseoStorico Alfa Romeo, Milan – well worth a visit
Operating with Alessandro Gronchi (centre) and Marco Fiore (right) at the IstitutoNazionale Dei Tumori, Milan, Italy