Marcovalerio Melis, M.D.

Effect of intra-operative fluid volume on peri-operative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma
Melis M; Marcon F; Masi A; Sarpel U; Miller G; Moore H; Cohen S; Berman R; Pachter HL; Newman E
2012 Jan;105(1):81-4 L, Journal of surgical oncology
BACKGROUND: Excess use of intravenous fluid can increase post-operative complications. We examined the influence of intra-operative crystalloid (IOC) administration on complications following pancreaticodudenectomy (PD) for pancreatic adenocarcinoma. METHODS: We categorized 188 patients who underwent PD for adenocarcinoma (1990-2009) into two groups: Group I received <6,000 ml and Group II received >/=6,000 ml IOC. Differences between groups in length of stay, overall morbidity, and 30-day mortality were evaluated. RESULTS: There were 86 patients in Group I and 102 in Group II. Group I patients were older and with higher percentage of women, but similar in regards to performance status, ASA score, underlying comorbidities, and administration of neo-adjuvant treatment. Group II patients had longer operations, increased blood loss, and higher rates of intra-operative blood transfusions. There were two post-operative deaths, both in the Group II (P = 0.5). Post-operative overall morbidity was 45.7%, without differences between the two groups (44.2% vs. 47.1%, P = 0.7). Likewise, length of post-operative stay was similar in both groups (13.8 days vs. 14.5 days, P = 0.5). CONCLUSIONS: The volume of IOC increased with duration of surgery, intra-operative blood losses, and intra-operative blood transfusion, but did not correlate with post-operative morbidity. J. Surg. Oncol (c) 2011 Wiley-Liss, Inc
— id: 136611, year: 2012, vol: 105, page: 81, stat: Journal Article,

Advances in the Management of Hepatocellular Carcinoma
Aytaman A; Aquino T; Serafini F; Leaf A; Somrov S; Kaufman M; Melis M
2011 ;28(Suppl 6):?-?, Federal practitioner
— id: 139907, year: 2011, vol: 28, page: ?, stat: Journal Article,

Meta-analysis of trials comparing minimally-invasive and open liver resections for hepatocellular carcinoma
Fancellu A.; Rosman A.S.; Sanna V.; Nigri G.R.; Zorcolo L.; Pisano M.; Melis M.
2011 ;171(1):e33-e45, Journal of surgical research
Background: Recent literature suggests that minimally-invasive hepatectomy (MIH) for hepatocellular carcinoma (HCC) is associated with better perioperative results and similar oncologic outcomes compared to open hepatectomy (OH). However, previous reports have been limited by small sample size and single-institution design. Methods: To overcome these limitations, we performed a meta-analysis of studies comparing MIH and OH in patients with HCC using a random-effects model. Results: Nine eligible studies were identified that included 227 patients undergoing MIH and 363 undergoing OH. Patients were similar respect to age, gender, rates of cirrhosis, hepatitis C infection, tumour size, and American Society of Anesthesiology classification. The MIH group had lower rates of hepatitis B infection. There were no differences in type of resection (anatomic or non-anatomic), use of Pringle's maneuver, and operative time. Patients undergoing MIH had less blood loss [difference -217 mL; 95% confidence interval (CI), -314 to -121], lower rates of transfusion [odds ratio (OR), 0.38; 95% CI, 0.24 to 0.59], shorter postoperative stay (difference -5 days; 95% CI, -7.84 to -2.25), lower rates of positive margins (OR, 0.30; 95% CI, 0.12 to 0.69) and perioperative complications (OR, 0.45; 95% CI, 0.31 to 0.66). Survival outcomes were similar in the two groups. Conclusions: Although patient selection might have influenced some of the observed outcomes, MIH was associated with decreased blood loss, transfusions, rates of positive resection margins, overall and specific morbidity, and hospital stay. Survival outcomes did not differ between MIH and OH, although further studies are needed to evaluate the impact of MIH on long-term results. 2011 Published by Elsevier Inc. All rights reserved
— id: 140543, year: 2011, vol: 171, page: e33, stat: Journal Article,

Percutaneous treatment of thoracic duct injuries
Marcon, Francesca; Irani, Katayun; Aquino, Theresa; Saunders, John K; Gouge, Thomas H; Melis, Marcovalerio
2011 Sep;25(9):2844-2848, Surgical endoscopy
BACKGROUND: Major thoracic or neck surgery or penetrating trauma can cause injury to the thoracic duct and development of a chylothorax. Chylothorax results in metabolic and immunologic disorders that can be life threatening, with a mortality rate reaching 50%. The management of chyle leaks is dependent on the etiology and daily output. Interventions are used to treat only leaks unresponsive to medical management or those with an output exceeding 1,000 ml/day. METHODS: This study reviewed the existing literature on the percutaneous management of chyle leaks. The authors evaluated five case series and three case reports inclusive of 90 patients in which percutaneous treatment for chylothorax was attempted between 1998 and 2004. RESULTS: For 71 patients, percutaneous treatment was technically successful, and chylothorax resolved in 49 of the patients (69%). Percutaneous treatment of chylothorax was associated with a 2% morbidity rate and no mortality. For 19 patients whose percutaneous approach failed, either surgical ligation or pleurodesis was performed. CONCLUSIONS: The percutaneous management of chyle leak is feasible, with low morbidity and mortality rates and a high rate of effectiveness. This approach should be considered before more invasive procedures
— id: 136938, year: 2011, vol: 25, page: 2844, stat: Journal Article,

The Moffitt prognostic model for prediction of survival after pancreaticoduodenectomy
Melis M.; Marcon F.; Masi A.; Sarpel U.; Miller G.; Moore H.; Cohen S.; Berman R.; Pachter H.L.; Newman E.
2011 ;18:S130-S130, Annals of surgical oncology
Background: The AJCC staging for pancreatic cancer is relatively non-discriminatory for prediction of survival after resection. At the Moffitt Cancer Center a prognostic score for patients with localized pancreatic cancer (AJCC <= IIb) has been developed. In the Moffitt Prognostic Index (MPI) patients are grouped in 5 risk categories on the basis of extra-pancreatic tumor extension, degree of differentiation and lymphatic invasion. The aim of this study is to assess the MPI's predictive value in an independent cohort of patients who underwent pancreaticoduodenectomy (PD) at the New York University. Methods From our retrospective pancreatic adenocarcinoma database of 248 patients, we identified and grouped by MPI category patients with AJCC stage <= IIb who underwent PD (1990-2009). Differences between groups were evaluated using ANOVA and chi-squared test. Overall survival (OS) for each group was estimated using the Kaplan-Meier method and compared using the log-rank statistic. Results Among 131 patients with stage Ia-IIb cancer, MPI could be calculated for 126 (96%). Only few patients fell in MPI lower-risk groups 1- 4 (respectively 1, 4, 3, 22), while the majority (96, 76.1%) fell in MPI group 5 (poor prognosis). The 5 groups were similar in demographics, underlying comorbidities, laboratory data, ASA score and ECOG performance status. There were no differences in operative time, blood loss, intra- and post-operative complications, length of stay, 30-day mortality. Pathology revealed more advanced stage in groups 3 to 5 (p=0.001). At mean follow-up of 18 months, there was no difference in median OS across MPI groups (respectively 19, 6, 16, 17, 12 months, p=0.91). Of note, AJCC staging did correlate with median OS (respectively 43, 12, 16, 11 months in stages Ia to IIb, p = 0.004). Conclusions In our experience the MPI performed worse than AJCC staging as a prognostic tool. The clustering of patients in the worst-prognosis group defied the very purpose of prognosis discrimination. Furthermore, in our experience MPI did not correlate with overall survival in patients undergoing DP for earlystage (<= IIb) pancreatic cancer
— id: 127250, year: 2011, vol: 18, page: S130, stat: Journal Article,

Safety of pancreaticoduodenectomy in patients older than 80 years: Risk vs. benefits
Melis M.; Marcon F.; Sarpel U.; Miller G.; Moore H.; Cohen S.; Berman R.; Pachter H.L.; Newman E.
2011 ;18:S101-S101, Annals of surgical oncology
Introduction: Surgery offers the only chance for cure in patients with pancreatic cancer. Currently, pancreaticoduodenectomy can be performed with a mortality of under 5% and a morbidity of 40-50%. Little, however, is known about outcomes of pancreaticoduodenectomy (PD) in octogenarians. This manuscript details outcomes after PD for adenocarcinoma in patients 80 years and older. Methods: From our comprehensive pancreatic adenocarcinoma database of 248 patients, we identified 200 patients who underwent PD (1990-2009). We categorized patients into two groups, according to age at time of surgery: Group I (>= 80 year-old) and Group II (< 80 year-old). The study end-points were length of post-operative stay (LOS), overall morbidity, 30-day mortality, overall survival (OS). Differences between groups were evaluated using t-test or chi-squared test. Survival was compared using Kaplan-Meier analysis and log-rank test. Results: There were 25 patients in group I (mean age 83.1) and 175 patients in Group II (mean age 64.4). Octogenarians had worse ECOG performance status (PS >= 1 in 90% vs. 50.8%, p < 0.01) and ASA score (ASA 3- 4 in 70.8% vs. 47.4%, p < 0.01). The two groups were similar in regard to underlying co-morbidities (including coronary artery disease, COPD, diabetes, chronic renal failure), operative time, rates of portal vein resection, intraoperative complications, blood loss, pathologic AJCC stage, status of resection margins. Octogenarians had longer LOS (20 vs. 13.7 days, p=0.01) and higher overall morbidity (68% vs. 44%, p=0.03). There was a single death in each group (p=0.23). At median follow-up of 13 months older patients had a median OS of 17.3 months compared to 13.1 months in younger patients (p=0.06). Conclusions: Surgical morbidity and LOS are significantly increased in octogenarians. However 30-day mortality was not significantly increased and OS was superior (but not statistically significant) when compared to younger patients. The decision for PD should be individualized and offered to carefully selected octogenarians
— id: 127249, year: 2011, vol: 18, page: S101, stat: Journal Article,

An elevated body mass index does not reduce survival after esophagectomy for cancer
Melis, Marcovalerio; Weber, Jill M; McLoughlin, James M; Siegel, Erin M; Hoffe, Sarah; Shridhar, Ravi; Turaga, Kiran K; Dittrick, George; Dean, E Michelle; Karl, Richard C; Meredith, Kenneth L
2011 Mar;18(3):824-831, Annals of surgical oncology
BACKGROUND: Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer. METHODS: Overall and disease-free survivals in obese (BMI >/= 30), overweight (BMI 25-29), and normal-weight (BMI 20-24) patients undergoing esophagectomy constituted the study end points. Survivals were calculated by the Kaplan-Meier method, and differences were analyzed by log rank method. RESULTS: The study included 166 obese, 176 overweight, and 148 normal-weight patients. These three groups were similar in terms of demographics and comorbidities, with the exception of younger age (62.5 vs. 66.2 vs. 65.3 years, P = 0.002), and higher incidence of diabetes (23.5 vs. 11.4 vs. 10.1%, P = 0.001) and hiatal hernia (28.3 vs. 14.8 vs. 20.3%, P = 0.01) in obese patients. Rates of adenocarcinoma histology were higher in obese patients (90.8 vs. 90.9 vs. 82.5%, P = 0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6 vs. 54.5 vs. 66.2%, P = 0.004). Response to neoadjuvant treatment, type of surgery performed, extent of lymphadenectomy, rate of R0 resections, perioperative complications, and administration of adjuvant chemotherapy were not influenced by BMI. At a median follow-up of 25 months, 5-year overall and disease-free survivals were longer in obese patients (respectively, 48, 41, 34%, P = 0.01 and 48, 44, 34%, P = 0.01). CONCLUSIONS: In our experience, an elevated BMI did not reduce overall and disease-free survivals after esophagectomy for cancer
— id: 124091, year: 2011, vol: 18, page: 824, stat: Journal Article,

Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies
Nigri, Giuseppe R; Rosman, Alan S; Petrucciani, Niccolo; Fancellu, Alessandro; Pisano, Michele; Zorcolo, Luigi; Ramacciato, Giovanni; Melis, Marcovalerio
2011 May;25(5):1642-1651, Surgical endoscopy
BACKGROUND: The current literature suggests that minimally invasive distal pancreatectomy (MIDP) is associated with faster recovery and less morbidity than open surgery. However, most studies have been limited by a small sample size and a single-institution design. To overcome this problem, the first metaanalysis of studies comparing MIDP and open distal pancreatectomy (ODP) has been performed. METHODS: A systematic literature review was conducted to identify studies comparing MIDP and ODP. Perioperative outcomes (e.g., morbidity and mortality, pancreatic fistula rates, blood loss) constituted the study end points. Metaanalyses were performed using a random-effects model. RESULTS: For the metaanalysis, 10 studies including 349 patients undergoing MIDP and 380 patients undergoing ODP were considered suitable. The patients in the two groups were similar with respect to age, body mass index (BMI), American Society of Anesthesiology (ASA) classification, and indication for surgery. The rate of conversion from full laparoscopy to hand-assisted procedure was 37%, and that from minimally invasive to open procedure was 11%. Patients undergoing MIDP had less blood loss, a shorter time to oral intake, and a shorter postoperative hospital stay. The mortality and reoperative rates did not differ between MIDP and ODP. The MIDP approach had fewer overall complications [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27-0.89], major complications (OR, 0.57; 95% CI, 0.34-0.96), surgical-site infections (OR, 0.32; 95% CI, 0.19-0.53), and pancreatic fistulas (OR, 0.68; 95% CI, 0.47-0.98). CONCLUSIONS: The MIDP procedure is feasible, safe, and associated with less blood loss and overall complications, shorter time to oral intake, and shorter postoperative hospital stay. Furthermore, the minimally invasive approach reduces the rate of pancreatic leaks and surgical-site infections after ODP
— id: 134107, year: 2011, vol: 25, page: 1642, stat: Journal Article,

Safety of hepatic resections in obese veterans
Saunders J.K.; Rosman A.S.; Neihaus D.; Gouge T.H.; Melis M.
2011 ;13:60-60, HPB : the official journal of the International Hepato Pancreato Biliary Association
Introduction: We aimed to determine the effects of body mass index (BMI) on outcomes after liver resection performed at the Veteran Administration. Methods: We queried the VASQIP database for liver resections (2005-2008), and grouped the patients into fi ve categories: normal weight (NW, BMI 18.5-24.9), overweight (OW, BMI 25-29.9) Class 1 (OB1, BMI 30-34.9), Class 2 (OB2, BMI 35-39.9), and Class 3 obesity (OB3, BMI >= 40). Differences in risk factors and perioperative complications across groups were analyzed. Results: Of 403 patients who underwent hepatectomy, 106 (26.3%) were NW, 161 (40.0%) OW, 94 (23.3%) OB1, 31 (7.7%) OB2, and 11 (2.7%) OB3. The BMI groups were similar in patient gender, age, diagnosis (90.3% malignancy), ASA class, rates of alcohol abuse, ascites, esophageal varices, and neoadjuvant treatment. Higher BMI was associated with increased rates of diabetes (18% vs. 27% vs. 36% vs. 39% vs. 45%, p 0.04) and lower incidence of smokers (53% vs. 35% vs. 30% vs. 16% vs. 9%, p 0.0001). There were no differences in type of resection performed, operative time, work RVU. OB3 received more blood transfusions (OB3 4.3 +/- 2.7 vs. NW 1.1 +/- 0.2, p 0.02). There were no differences across BMI groups in overall and specifi c morbidity, as well in length of stay. Nevertheless, compared to the other groups OB3 had a higher 30-day mortality (27% vs. 6%, 0.05). Multivariate analyses confi rmed BMI > 40 as an independent predictor of post-operative mortality. Conclusion: Obesity did not increase post-operative complications in veterans after liver resection. Mortality was higher in patients with BMI > 40
— id: 127251, year: 2011, vol: 13, page: 60, stat: Journal Article,

A meta-analysis of prospective randomized trials comparing minimally invasive and open distal gastrectomy for cancer
Zorcolo L.; Rosman A.S.; Pisano M.; Marcon F.; Restivo A.; Nigri G.R.; Fancellu A.; Melis M.
2011 ;104(5):544-551, Journal of surgical oncology
Current literature suggests that minimally invasive distal gastrectomy (MIDG) may enhance post-operative recovery and decrease morbidity compared to open surgery (ODG) in patients with gastric cancer. A meta-analysis of six Prospective Randomized Trials comparing MIDG (343 patients) and ODG (323 patients) for gastric cancer was conducted. MIDG was associated with increased operative time, reduced blood loss and overall morbidity. There was not sufficient data to draw solid conclusions about the oncologic quality of MIDG. 2011 Wiley-Liss, Inc
— id: 137855, year: 2011, vol: 104, page: 544, stat: Journal Article,

Meta-analysis of Trials Comparing Minimally-invasive and Open Liver Resections for Hepatocellular Carcinoma
Fancellu, A; Rosman, A; Sanna, V; Nigri, GR; Zorcolo, L; Pisano, M; Melis, M
2010 FEB ;17(6):S74-S74, Annals of surgical oncology
— id: 110004, year: 2010, vol: 17, page: S74, stat: Journal Article,

Addressing work force issues with foreign medical graduates
Kaafarani H; Moller MG; Prabhakaran S; Melis M
2010 ;95:27-32, Bulletin of the American College of Surgeons
— id: 111339, year: 2010, vol: 95, page: 27, stat: Journal Article,

Body mass index and oncologic outcomes after esophagectomy
Melis, M; Meredith, K L; McLoughlin, J M; Weber, J M; Siegel, E M; Hoffe, S; Turaga, K K; Dittrick, G; Dean, E M; Karl, R C
2010 Feb;158(2):259-260, Journal of surgical research
— id: 106380, year: 2010, vol: 158, page: 259, stat: Journal Article,

Gene expression profiling of colorectal mucinous adenocarcinomas
Melis, Marcovalerio; Hernandez, Jonathan; Siegel, Erin M; McLoughlin, James M; Ly, Quan P; Nair, Rajesh M; Lewis, James M; Jensen, Eric H; Alvarado, Michael D; Coppola, Domenico; Eschrich, Steve; Bloom, Gregory C; Yeatman, Timothy J; Shibata, David
2010 Jun;53(6):936-943, Diseases of the colon & rectum
PURPOSE: Although mucinous adenocarcinomas represent 6% to 19% of all colorectal adenocarcinomas, little is known about the genome-wide alterations associated with this malignancy. We have sought to characterize both the gene expression profiles of mucinous adenocarcinomas and their clinicopathologic features. METHODS: Tumors from 171 patients with primary colorectal cancer were profiled using the Affymetrix HG-U133Plus 2.0 GeneChip with characterization of clinicopathologic data. Gene ontology software was used to identify altered biologic pathways. RESULTS: Twenty (11.7%) mucinous adenocarcinomas and 151 (89.3%) nonmucinous adenocarcinomas were identified. Mucinous adenocarcinomas were more likely to be diagnosed with lymph node (LN) metastases (75% vs 51%, P = .04) and at a more advanced stage (85% vs 54%, P = .006) but long-term survival (5-y survival 58.9% vs 58.7%, P = NS) was similar. Mucinous adenocarcinomas displayed 182 upregulated and 135 downregulated genes. The most upregulated genes included those involved in cellular differentiation and mucin metabolism (eg, AQP3 + 4.6, MUC5AC +4.2, MUC2 + 2.8). Altered biologic pathways included those associated with mucin substrate metabolism (P = .002 and .02), amino acid metabolism (P = .02), and the mitogen-activated protein kinase cascade (P = .02). DISCUSSION: Using gene expression profiling of mucinous adenocarcinomas, we have identified the differential upregulation of genes involved in differentiation and mucin metabolism, as well as specific biologic pathways. These findings suggest that mucinous adenocarcinomas represent a genetically distinct variant of colorectal adencarcinoma and have implications for the development of targeted therapies
— id: 109795, year: 2010, vol: 53, page: 936, stat: Journal Article,

Evidence-based surgical practice in academic medical centers: consistently anecdotal?
Melis, Marcovalerio; Karl, Richard C; Wong, Sandra L; Brennan, Murray F; Matthews, Jeffrey B; Roggin, Kevin K
2010 May;14(5):904-909, Journal of gastrointestinal surgery
INTRODUCTION: Randomized trials, meta-analyses, and guidelines form the basis of clinical decision making. We queried a small sample of surgeons at three academic medical centers to determine whether key elements of surgical practice were concordant with available evidence. MATERIALS AND METHODS: A French Society of Digestive Surgery (FSDS) questionnaire was submitted to general surgery trainees and faculty at the University of South Florida and University of Chicago and to surgical oncology fellows at the Memorial Sloan-Kettering Cancer Center. Participants were asked to respond 'never,' 'rarely,' 'often,' or 'always' to 13 questions involving different aspects of gastrointestinal surgery. For each question, a correct evidence-based answer was available from published studies. RESULTS AND DISCUSSION: One hundred ten surgeons (79% of eligible participants) completed the survey. Only 60% of the answers were concordant with existing data. The percentages of correct answers did not differ significantly according to institution or level of experience of participants. The low frequency of correct responses in our subjects paralleled the findings from the 2004 FSDS study. Variability in the quality of evidence and ambiguity in the survey questions may have influenced the responses, but evidence-based medicine does not appear to uniformly influence clinical decision making
— id: 109040, year: 2010, vol: 14, page: 904, stat: Journal Article,

Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer
Meredith, Kenneth L; Weber, Jill M; Turaga, Kiran K; Siegel, Erin M; McLoughlin, Jim; Hoffe, Sarah; Marcovalerio, Melis; Shah, Nilay; Kelley, Scott; Karl, Richard
2010 Apr;17(4):1159-1167, Annals of surgical oncology
BACKGROUND: Esophageal cancer remains a malignancy with high morbidity and mortality despite improvements to diagnosis, staging, chemotherapy, radiation, and surgery. Neoadjuvant therapy (NT) may improve oncologic outcome in many patients, however the degree to which patients benefit remains unclear. We examined the relationship between pathologic response to NT and magnitude of benefit in patients with esophageal cancer. METHODS: Using a comprehensive esophageal cancer database, we identified patients who underwent esophagectomy between 1994 and 2008. Pathologic response was denoted as complete (pCR), partial (pPR), and nonresponse (NR). Clinical and pathologic data were compared using Fisher's exact and chi-square when appropriate, while Kaplan-Meier estimates were used for survival analysis. RESULTS: We identified 347 patients who underwent esophagectomy, and 262 (75.5%) were treated with NT. The median age was 66 years (28-86 years) with median follow-up of 20 months (1-177 months). There were 106 (40.5%) patients exhibiting pCR, 95 (36.3%) with pPR, and 61 (23.3%) with NR. The rate of R0 resections was higher amongst pCR (100%) compared with 94.7% in pPR (P = 0.02) and 87.5% in NR (P = 0.0007). There were 15 (14.2%) recurrences in pCR, 22 (23.7%) in pPR, and 17 (28.8%) in NR (P = 0.04). Patients achieving pCR had 5-year disease-free survival (DFS) and overall survival (OS) of 52% and 52%, respectively, compared with 36% and 38% in pPR and 22% and 19% in NR (P < 0.0001, P < 0.0001). CONCLUSIONS: Esophageal cancer patients frequently succumb to their disease. However, patients treated with neoadjuvant therapy who achieve pCR have a higher rate of R0 resections, fewer recurrences, and improved 5-year OS and DFS
— id: 109666, year: 2010, vol: 17, page: 1159, stat: Journal Article,

Histologic characteristics enhance predictive value of American Joint Committee on Cancer staging in resectable pancreas cancer
Helm, James; Centeno, Barbara A; Coppola, Domenico; Melis, Marcovalerio; Lloyd, Mark; Park, Jong Y; Chen, Dung-Tsa; Malafa, Mokenge P
2009 Sep 15;115(18):4080-4089, Cancer
BACKGROUND: American Joint Committee on Cancer (AJCC) anatomic stage group is considered relatively nondiscriminatory for predicting differences in survival after pancreatectomy for ductal adenocarcinoma, a perception confirmed in the authors' patients and by other reports. The authors' aim was to investigate the potential for improving the predictive value of AJCC staging by incorporating individually predictive histologic features into AJCC tumor-node-metastasis classification of anatomic extent, and determine the simplest combination of tumor characteristics predicting survival. METHODS: The authors determined survival of 137 patients who underwent pancreatectomy for ductal adenocarcinoma with curative intent (stage Groups IA-IIB) at Moffitt Cancer Center during the last 2 decades using data obtained from medical record review, the Moffitt Cancer Registry, and the Social Security Death Index. Histologic characteristics were confirmed by expert review. RESULTS: Median survival was 21.2 months after pancreatectomy with a 3-year disease-specific survival of 36%. Univariate Kaplan-Meier analysis and multivariate Cox proportional hazard modeling found worse survival with local extrapancreatic extension, poorly differentiated histology, and lymphatic invasion within tumor (P<.05). Survival was not worse with nodal metastases, microscopically positive resection margins, and perineural or venous invasion, nor was survival better with cancer arising from an intraductal papillary mucinous neoplasm. Kaplan-Meier estimates for different variable combinations showed prognosis was best for well- or moderately differentiated tumors without lymphatic invasion and confined to the pancreas (9.9 years median survival), worst for poorly differentiated tumors with lymphatic invasion and local extension beyond the pancreas (8.5 months median survival), and intermediate for well- or moderately differentiated tumors with either lymphatic invasion or local extension beyond the pancreas (21.2 months median survival). CONCLUSIONS: A simple combination of tumor differentiation, lymphatic invasion within the tumor, and local extrapancreatic extension predicts survival after pancreatectomy for ductal adenocarcinoma
— id: 102618, year: 2009, vol: 115, page: 4080, stat: Journal Article,

Full thickness transanal re-excision following endoscopic removal of malignant rectal polyps
Melis, Marcovalerio; Gruel, Renee; Darwin, Peter; Drachenberg, Cinthia; Shibata, David
2009 May;24(5):531-536, International journal of colorectal disease
PURPOSE: Segmental resection is recommended for malignant polyps of the colon that are removed endoscopically with questionable margins. However, when such a lesion is present in the rectum, radical resection may involve a higher risk procedure such as low anterior resection or abdominoperineal resection. We report our long-term results in patients treated by transanal re-excision (TAR) following endoscopic removal of malignant rectal polyps (MRP). METHODS: Twenty-three patients were identified between 2000 and 2006 as having undergone TAR following complete gross endoscopic removal of an MRP. All lesions demonstrated close, unclear, or microscopically positive polypectomy margins. RESULTS: Our population consisted of 13 men and 10 women with a median age of 61 years (range 52-86). Seventeen (74%) patients demonstrated no evidence of residual tumor. Six patients were found to have residual disease (three adenoma, two adenocarcinoma, one positive lymph node). Morbidity was minimal, and there were no mortalities. At a median follow-up of 64.6 months (range 11-90), there have been no recurrences. CONCLUSION: We conclude that in approximately one quarter of patients, residual disease is identified following TAR. Given the relatively safety and the low recurrence rate associated with this procedure, TAR may be considered as an alternative to radical resection for MRPs with unsatisfactory margins
— id: 95442, year: 2009, vol: 24, page: 531, stat: Journal Article,

Correlations Between Neoadjuvant Treatment, Anemia, and Perioperative Complications in Patients Undergoing Esophagectomy for Cancer
Melis, Marcovalerio; McLoughlin, James M; Dean, E Michelle; Siegel, Erin M; Weber, Jill M; Shah, Nilay; Kelley, Scott T; Karl, Richard C
2009 May 1;153(1):114-120, Journal of surgical research
INTRODUCTION: The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection. METHODS: From a retrospective esophageal database, 413 patients were identified. Anemia was defined according to the World Health Organization classification of <13 g/dL or <12 g/dL for men or women, respectively. Statistical analysis was performed with analysis of variance, Pearson's chi(2), or Fisher exact test as appropriate. The independent association of anemia, blood transfusion, and combined modality treatment on risk of postoperative complications were examined using multiple logistic regression. RESULTS: Information on combined modality treatment, preoperative hemoglobin levels, and blood transfusion was available for 413 patients, of whom 57% received combined modality treatment. Overall 197 (47.6%) patients were preoperatively found to be anemic, and those who had received combined modality treatment were more likely to be anemic (60.6% versus 30.7%, P < 0.001). Anemic patients required more blood transfusions than nonanemic patients (46.7% versus 29.6%, P < 0.001). Seventy-five percent of patients who required transfusion during the hospital stay had received combined modality treatment (P = 0.01). Combined modality treatment and anemia were not associated with increased risk of complications. Patients with any perioperative complication and surgical site infections were more likely to have received blood transfusion compared to patients without complications (OR = 1.73; 95% CI 1.04-2.87 and OR = 2.98; 95% CI 1.04-8.55; respectively). CONCLUSIONS: Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer
— id: 95441, year: 2009, vol: 153, page: 114, stat: Journal Article,

PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms
Farma, Jeffrey M; Santillan, Alfredo A; Melis, Marcovalerio; Walters, Janet; Belinc, Daly; Chen, Dung-Tsa; Eikman, Edward A; Malafa, Mokenge
2008 Sep;15(9):2465-2471, Annals of surgical oncology
BACKGROUND: The role of fusion positron emission tomography/computed tomography scans (PET/CT) in staging of patients with pancreatic neoplasms (PN) is poorly defined. PET/CT may serve as an adjunct to standard imaging by increasing occult metastases detection. The purpose of this study was to assess the additional value, in relation to computed tomography (CT), of PET/CT imaging for patients with PN. METHODS: Eighty-two patients with potentially resectable PN underwent staging with PET/CT and CT of the chest and abdomen. Sensitivity of diagnosing pancreatic cancer by PET/CT avidity was evaluated. The sensitivity of detecting metastases was compared between PET/CT, standard CT, and the combination of PET/CT and CT. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT. RESULTS: The sensitivity and specificity of PET/CT in diagnosing pancreatic cancer were 89% and 88%, respectively. Sensitivity of detecting metastatic disease for PET/CT alone, standard CT alone, and the combination of PET/CT and CT were 61%, 57%, and 87%, respectively. Findings on PET/CT influenced the clinical management in seven patients (11%), two with a supraclavicular lymph node (LN), two occult liver lesions, two peritoneal implants, and one peri-esophageal LN. CONCLUSION: This study evaluated PET/CT in the initial work-up of patients with PN. PET/CT increased sensitivity (87%) for detection of metastatic disease when combined with standard CT. In invasive cancer, PET/CT changed the management in 11% of our patients. PET/CT should be considered in the initial work-up of patients with potentially resectable pancreatic lesions
— id: 90726, year: 2008, vol: 15, page: 2465, stat: Journal Article,

Are patients with esophageal cancer who become PET negative after neoadjuvant chemoradiation free of cancer?
McLoughlin, James M; Melis, Marcovalerio; Siegel, Erin M; Dean, E Michelle; Weber, Jill M; Chern, Jeannie; Elliott, Melanie; Kelley, Scott T; Karl, Richard C
2008 May;206(5):879-886, Journal of the American College of Surgeons
BACKGROUND: Esophageal cancer continues to increase in incidence. Many patients are presenting with stage II or greater disease and proceeding to neoadjuvant chemoradiation therapy before resection. Approximately 30% of patients will achieve a complete response and might not benefit from proceeding to resection. This study will examine the ability of PET to predict patients with a complete pathologic response. STUDY DESIGN: A query of our IRB-approved esophageal database revealed 81 patients who underwent a pre- and postchemoradiation PET scan and then proceeded to esophageal resection. Statistical analysis was performed to determine the ability of PET to predict a complete pathologic response. RESULTS: When comparing posttherapy PET with final pathology, it was determined that PET could not consistently differentiate a complete pathologic response from patients who still had persistent disease. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 61.8%, 43.8%, 70%, 35%, and 56%, respectively, for patients with a complete PET response after neoadjuvant therapy. CONCLUSIONS: A complete PET response after neoadjuvant chemoradiation is not substantially predictive of a complete pathologic response. Patients should still be referred for resection unless distant metastases are identified
— id: 90727, year: 2008, vol: 206, page: 879, stat: Journal Article,

Multimodality management of desmoid tumors: how important is a negative surgical margin?
Melis, Marcovalerio; Zager, Jonathan S; Sondak, Vernon K
2008 Dec 15;98(8):594-602, Journal of surgical oncology
Desmoid tumors are rare, locally invasive mesenchymal tumors without metastatic potential. Their clinical behavior is heterogeneous and characteristically unpredictable; outcomes are influenced by anatomic location, proximity to vital organs, association with familial adenomatous polyposis. Surgery is the main treatment modality, but the significance of positive resection margins remains controversial since they may not increase the risk of recurrence: in this setting re-resection, adjuvant radiation or close clinical follow-up could all be appropriate options. We reviewed the current evidence for multimodality therapy of desmoids, with a focus on the importance of resection margins, and present our own algorithm for treatment
— id: 91324, year: 2008, vol: 98, page: 594, stat: Journal Article,

Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients
Melis, M
2007 Aug;21(8):1469-1469, Surgical endoscopy
— id: 90939, year: 2007, vol: 21, page: 1469, stat: Journal Article,

Synchronous colorectal adenocarcinoma and gastrointestinal stromal tumor (GIST)
Melis, Marcovalerio; Choi, Eugene A; Anders, Robert; Christiansen, Peter; Fichera, Alessandro
2007 Feb;22(2):109-114, International journal of colorectal disease
BACKGROUND: Little is known about the synchronous occurrence of gastrointestinal stromal tumors (GISTs) and other gastrointestinal tumors. We present two cases of an invasive colon cancer with a synchronous small-bowel GIST; immunohistochemistry studies were performed to evaluate possible genetic similarities. METHODS: This paper reports two cases of synchronous GISTs and colorectal cancer (CRC) with immunohistochemistry analysis of c-Kit expression. This paper is also a review of the existing literature on the association of GISTs and CRC and the role of c-Kit in CRC. RESULTS: In the last 2 years, we observed two patients with synchronous CRCs and GISTs of the small bowel. The GISTs were incidentally discovered during the work-up for CRCs and excised at the time of the colon resection. Immunohistochemistry study did not reveal an expression of c-Kit in CRCs. Clinical implications of the association between these two neoplasms are described in this paper. CONCLUSIONS: Synchronous CRC and GIST has been more frequently reported. Because of the limited number of cases, we cannot exclude an incidental relationship. The genetic pathways of tumorigenesis appear different for the two neoplasms. Further studies are needed to clarify a possible role of c-Kit in the development of colonic adenocarcinomas
— id: 90730, year: 2007, vol: 22, page: 109, stat: Journal Article,

Successful palliation of hypercalcemia secondary to metastatic parathyroid cancer: an unusual indication for hepatic resection
Mezhir, James J; Melis, Marcovalerio; Headley, Ryan C; Pai, Rish K; Posner, Mitchell C; Kaplan, Edwin L
2007 ;14(4):410-413, Journal of hepato-biliary-pancreatic surgery
Primary carcinoma of the parathyroid gland is a rare disease. It is often diagnosed after recurrence of hyperparathyroidism following resection for presumed adenomatous disease. Local and distant recurrence is high and aggressive resection is advocated. Patients with parathyroid cancer are frequently plagued by severe hypercalcemia, which is often refractory to medical therapy. Herein we describe the case of a patient with metastatic parathyroid cancer localized to the liver. The patient was treated with a palliative hepatic resection for the management of persistent and refractory hypercalcemia. Intraoperative parathyroid hormone levels were utilized as an adjunct to determine successful metastatectomy. Our case highlights the importance of an aggressive approach to patients with metastatic parathyroid cancer, as well as the utility of intraoperative parathyroid hormone levels to confirm successful extirpation of disease
— id: 90728, year: 2007, vol: 14, page: 410, stat: Journal Article,

Laparoscopic Nissen fundoplication without division of short gastric vessels in children
Liu, Donald C; Lin, Tony; Statter, Mindy B; Glynn, Loretto; Melis, Marcovalerio; Chen, Yun; Zhan, Jianghua; Zimmermann, Beth T; Loe, William A; B Hill, Charles
2006 Jan;41(1):120-125, Journal of pediatric surgery
PURPOSE: It has been suggested that routine division of short gastric vessels (SGVs) results in a more 'floppy' Nissen fundoplication leading to improved outcomes, that is, less dysphagia and lower incidences of recurrent gastroesophageal reflux disease (GERD). The aim of this retrospective study was to assess whether laparoscopic Nissen fundoplication without division of SGVs (Rossetti modification) (laparoscopic Nissen-Rossetti fundoplication [LNRF]) is associated with acceptable clinical outcome in children. METHOD: The charts of 368 children who underwent LNRF between January 1996 and September 2004 by 1 primary surgeon were retrospectively reviewed. Children were divided into 2 groups: LNRF + gastrostomy (A) and LNRF alone (B). Mean follow-up period of all groups was 4.2 years. RESULTS: Laparoscopic Nissen-Rossetti fundoplication was completed in 99% (365/368). Mean operating time for group A was 74 minutes and 61 minutes for group B. None in group A required postoperative esophageal dilatation, and 9 in group B (22.5%) required 12 dilatations; 3.6% developed recurrent GERD, 3.7% in group A and 2.5% in group B. CONCLUSION: Laparoscopic Nissen-Rossetti fundoplication can be performed with acceptable long-term outcome in children, especially in the majority also requiring chronic gastrostomy access. Short-term, reversible dysphagia may be seen in a small percentage of children having fundoplication alone
— id: 90731, year: 2006, vol: 41, page: 120, stat: Journal Article,

Bowel necrosis associated with early jejunal tube feeding: A complication of postoperative enteral nutrition
Melis, Marcovalerio; Fichera, Alessandro; Ferguson, Mark K
2006 Jul;141(7):701-704, Archives of Surgery (Chicago)
HYPOTHESIS: Postoperative enteral nutrition may sometimes be responsible for severe complications such as mesenteri ischemia. DATA SOURCES: Studies in the English literature were identified by a computer-assisted search of the MEDLINE database using the key words 'enteral feeding OR jejunostomy' AND 'complications OR mesenteric ischemia.' Cited references of each retrieved paper were checked for relevance. STUDY SELECTION: All reports of mesenteric ischemia in the setting of postoperative enteral feeding were included. In cases of multiple articles from the same institution with overlapping patients, the most exhaustive article was included. DATA EXTRACTION: All reports were abstracted for number of patients, presence of preoperative comorbidities, development of perioperative hypotension or mesenteric occlusion, and outcome. DATA SYNTHESIS: Nine studies were retrieved in which enteral feedings were responsible for bowel ischemia; we report an additional case. The common clinical picture is that of a patient without significant risk factors for mesenteric ischemia, which during the early postoperative course develops nonspecific abdominal symptoms and then rapidly progresses to septic shock and eventually to multisystem organ failure and death. Mesenteric ischemia may present in up to 3.5% of enterally fed surgical patients; the associated mortality approaches 100%. The lack of specific symptoms requires a high index of suspicion for diagnosis; prompt abdominal exploration and bowel resection are the only chance for survival. CONCLUSIONS: The benefits of enteral nutrition outweigh the likelihood of severe complications; when mesenteric ischemia develops, early diagnosis is challenging and the prognosis is poor
— id: 90729, year: 2006, vol: 141, page: 701, stat: Journal Article,

Metaanalysis of trials comparing laparoscopic and open surgery for Crohn's disease
Rosman, A S; Melis, M; Fichera, A
2005 Dec;19(12):1549-1555, Surgical endoscopy
BACKGROUND: Several studies in the literature have suggested that laparoscopic surgery for Crohn's disease is associated with faster postoperative recovery and a morbidity and recurrence rate similar to that for open surgery. Most of these studies have been limited by a small sample size and a short follow-up period. METHODS: To clarify whether open or laparoscopic resection results in a better outcome, a metaanalysis of studies was performed comparing the two procedures for Crohn's disease. Pooled effects were estimated using a random-effects model. RESULTS: Laparoscopic surgery required more operative time than open surgery (26.8 min; 95% confidence interval [CI], 6.4-47.2 min), but resulted in a shorter duration of ileus and a decreased hospital stay (-2.62 days; 95% CI, -3.62 to -1.62). Laparoscopic surgery also was associated with a decreased rate for postoperative bowel obstruction and surgical recurrences. CONCLUSIONS: Laparoscopic surgery for Crohn's disease is feasible, safe, and associated with shorter duration of ileus and a shorter hospital stay
— id: 90938, year: 2005, vol: 19, page: 1549, stat: Journal Article,

[Levels of cytokines in mucosal biopsies of Crohn's colitis. Physiopatological observations]
Marongiu, L; Scintu, F; Melis, M V; Pisano, M; Zorcolo, L; Capra, F; Casula, G
2002 Feb;57(1):35-40, Minerva chirurgica
BACKGROUND: It is well known that mucosal concentrations of many pro and anti-inflammatory cytokines are elevated in diseased segments of colon in Crohn's colitis. The present study, showing preliminary results, aims to determine whether the IL-1beta, IL-6 and IL-8 levels are increased throughout the entire colon in patients with Crohn's colitis. METHODS: Five patients with active Crohn's colitis and five controls were studied by mucosal biopsies. In the diseased patients IL-1beta, IL-6 and IL-8 levels have been measured in both pathologic and normal appearing colonic mucosa. The concentration of these cytokines was assessed using ELISA and compared. Histological sections were also performed to confirm diseased segment of colon. RESULTS: The concentrations IL-1beta and IL-8 were much more higher in patients with Crohn's colitis when compared to controls. Moreover IL-1beta and IL-8 were more elevated in uninvolved colonic segments than on diseased segments. CONCLUSIONS: Our results confirm the finding of other authors that, although Crohn's colitis is a segmental disease, the concentration of IL-1beta and IL-8 in mucosal biopsies is increased throughout the entire colon. In particular our study shows that the concentrations of IL-1b and IL-8 is higher in uninvolved than involved colonic segments. These appearances favour the physio-pathologic hypothesis that Crohn's colitis involves the entire colon even when is not clinically or histologically apparent, and they suggest that uninvolved parts of colon may not be free of disease. Further studies are required to better understand the higher levels of cytokines found in macroscopically normal when compared to pathological mucosal in patients with Crohn's colitis
— id: 90930, year: 2002, vol: 57, page: 35, stat: Journal Article,

Primary hydatid cysts of psoas muscle
Melis, Marcovalerio; Marongiu, Luigi; Scintu, Francesco; Pisano, Michele; Capra, Fabio; Zorcolo, Luigi; Casula, Giuseppe
2002 Jun;72(6):443-445, ANZ journal of surgery
BACKGROUND: Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in muscle is not common, accounting for 2-3% of all sites; even rarer is the development of multiple cysts. METHODS: The patient presented with a painless abdominal mass which gradually increased in size to a diameter of approximately 16 cm. Organ imaging scan revealed multiple hydatid cysts within the right psoas muscle. Because of the proximity of the lesions to the iliac vessels, ureter and nerves to the lower limb, percutaneous drainage and alcoholization under local anaesthesia were -performed with the aim of reducing the size of the cysts and sterilizing them prior to definitive surgery. This procedure was not effective. Two weeks after percutaneous treatment the patient underwent surgery. RESULTS: At operation the cysts were localized and successfully removed under ultrasound guidance. Postoperative stay was -uneventful. Two years after surgery the patient has no evidence of recurrent hydatid disease. CONCLUSIONS: Ultrasonography is the preferred method for detecting muscular hydatid cyst and for guiding the surgeon during resection
— id: 90732, year: 2002, vol: 72, page: 443, stat: Journal Article,

Inflammatory cutaneous metastasis from rectal adenocarcinoma: report of a case
Melis, Marcovalerio; Scintu, Francesco; Marongiu, Luigi; Mascia, Roberto; Frau, Giovanni; Casula, Giuseppe
2002 Apr;45(4):562-563, Diseases of the colon & rectum
— id: 90733, year: 2002, vol: 45, page: 562, stat: Journal Article,

Primary closure of complicated perineal wounds with myocutaneous and fasciocutaneous flaps after proctectomy for Crohn's disease
Hurst, R D; Gottlieb, L J; Crucitti, P; Melis, M; Rubin, M; Michelassi, F
2001 Oct;130(4):767-772, Surgery
BACKGROUND: The purpose of this study is to detail the use of advanced tissue transfer techniques to achieve primary closure of the perineal wound after proctectomy for Crohn's disease. METHODS: Between October 1984 and March 2000, we performed proctectomy with permanent intestinal stoma in 97 patients with Crohn's disease. Twelve of these patients (12.4%) required at least 1 myocutaneous flap to achieve primary closure of the perineal wound. Details of each patient's perioperative course were recorded prospectively. RESULTS: All 12 patients had fistulizing perineal Crohn's disease combined with Crohn's proctitis. Two patients had a simultaneous anal adenocarcinoma. Indications for flap closure included management of large perineal skin defects (n = 11), reconstruction of the posterior vaginal wall (n = 2), and the need to fill a large pelvic dead space (n = 3). (Three patients had a combination of the previous indications). In total, 6 rectus abdominis, 5 gluteus maximus, 1 posterior thigh, 3 chimeric posterior thigh, and 1 latissimus dorsi flaps were performed. Six patients required more than 1 flap. Three patients had complications develop related to the flaps (2 wound hematomas and 1 seroma). Complete perineal healing was achieved in all patients. CONCLUSIONS: Complex tissue flap closure of the perineal wound after proctectomy for perineal complications of Crohn's disease should be considered when simple closure is not possible or when reconstruction of the posterior wall of the vagina is necessary
— id: 90935, year: 2001, vol: 130, page: 767, stat: Journal Article,

[Clinical relevance of unusual metastases from colorectal neoplasms]
Melis, M; Scintu, F; Pisano, M; Capra, F; Marongiu, L; Mocci, P; Casula, G
2001 Aug;56(4):329-335, Minerva chirurgica
BACKGROUND: The aim of the study was to evaluate the clinical relevance of isolated metastases (MII) in unusual sites (different from liver and lung), synchronous and metachronous, in patients operated on for colorectal carcinoma (CCR). METHODS: The study was performed on 655 patients who underwent surgery for CCR during the period 1985-2000. Work out for distance metastases was performed (both during preoperative evaluation and follow-up) with physical examination and other few exams (CEA, chest X-ray, abdominal US scan). Other investigations were carried out if requested by clinical features. Metastases localized in sites different from liver and lungs were considered unusual. RESULTS: Metastases in unusual sites usually are observed in patients with terminal neoplastic disease. MII was found in only 7 (1.07%) patients, all submitted to resection of the primary tumor. Sites of unusual metastases were bones (3), CNS (2), adrenal gland and anus; such lesions were easily diagnosed by clinical features or by few examinations. Curative treatment was feasible in only three patients, and actually it did improve neither survival, nor quality of life. CONCLUSIONS: Extra-abdominal MII are rare, generally they cannot be treated; therefore particular tests for early diagnosis of such lesions appear useless. Potentially curative surgery for splenic and adrenal metastases is described in the literature; anyhow these lesions are usually shown by routine investigations
— id: 90931, year: 2001, vol: 56, page: 329, stat: Journal Article,

Unusual metastasis from colorectal cancer
Capra F; Melis M; Pisano M; Mocci P; Scintu F
2000 ;6(Suppl):14-14, Ospedali d'Italia - chirurgia
— id: 90955, year: 2000, vol: 6, page: 14, stat: Journal Article,

Side-to-side isoperistaltic strictureplasty in extensive Crohn's disease: a prospective longitudinal study
Michelassi, F; Hurst, R D; Melis, M; Rubin, M; Cohen, R; Gasparitis, A; Hanauer, S B; Hart, J
2000 Sep;232(3):401-408, Annals of surgery
OBJECTIVE: To report on the results of a prospective longitudinal study of a new bowel-sparing procedure (side-to-side isoperistaltic strictureplasty [SSIS]) in patients with extensive Crohn's disease. METHODS: Between January 1992 and April 1999, the authors operated on 469 consecutive patients for Crohn's disease of the small bowel. Seventy-one patients (15.1%) underwent at least one strictureplasty; of these, 21 (4.5%; 12 men, 9 women; mean age 39) underwent an SSIS. The long-term changes occurring in the SSIS were studied radiographically, endoscopically, and histopathologically. RESULTS: The indication for surgical intervention was symptomatic partial intestinal obstruction in each of the 21 patients. Fourteen SSISs were constructed in the jejunum, four in the ileum, and three with ileum overlapping colon. The average length of the SSIS was 24 cm. Performance of an SSIS instead of a resection resulted in preservation of an average of 17% of small bowel length. One patient suffered a postoperative gastrointestinal hemorrhage. All patients were discharged on oral feedings after a mean of 8 days. In all cases, SSIS resulted in resolution of the preoperative symptoms. With follow-up extending to 7.5 years in 20 patients (one patient died of unrelated causes), radiographic, endoscopic, and histopathologic examination of the SSIS suggests regression of previously active Crohn's disease. CONCLUSIONS: SSIS is a safe and effective procedure in patients with extensive Crohn's disease. The authors' results provide radiographic, endoscopic, and histopathologic evidence that active Crohn's disease regresses at the site of the SSIS
— id: 90937, year: 2000, vol: 232, page: 401, stat: Journal Article,

Surgical treatment of anorectal complications in Crohn's disease
Michelassi, F; Melis, M; Rubin, M; Hurst, R D
2000 Oct;128(4):597-603, Surgery
BACKGROUND: The purpose of our study was to elucidate features, surgical procedures, and long-term results in patients with anorectal complications of Crohn's disease. METHODS: Physical findings, surgical treatment, and long-term outcome were recorded prospectively for 224 patients who had anorectal complications of Crohn's disease between October 1984 and May 1999. RESULTS: Presenting complications included abscess (n = 36), fistula-in-ano (n = 51), rectovaginal fistula (n = 20), anal stenosis (n = 40), anal incontinence (n = 11), or a combination of features (n = 66). Twenty-four patients did not undergo surgical treatment; the remaining 200 patients underwent 284 procedures. Ultimately, 139 patients (62%) retained anorectal function; reasons for proctectomy in the remaining 85 patients included disease (n = 66), extensive fistular disease (n = 15), fecal incontinence (n = 2), and tight anal stenosis (n = 1). Patients with rectal disease had a significantly higher rate of proctectomy than patients with rectal sparing (77.6% vs. 13.6%, respectively, P<.0001). In the absence of rectal involvement, patients with multiple complications had a significantly higher rate of proctectomy than patients with single complications (23% vs. 10%, P<.05). CONCLUSIONS: A wide spectrum of surgical techniques is required for the management of the diverse anorectal complications of Crohn's disease. Complete healing and control of sepsis can be achieved in the majority of patients. Active rectal disease and multiple complications significantly increase the need for proctectomy
— id: 90936, year: 2000, vol: 128, page: 597, stat: Journal Article,

The impact of an incomplete preoperative colonoscopy in patients with colorectal cancer
Scintu, F; D'Alia, G; Cabras, M; Zorcolo, L; Melis, M; Marongiu, L; Casula, G
2000 Mar-Apr;52(2):103-107, Chirurgia italiana
Total large bowel evaluation remains an essential step in the treatment of patients with colorectal cancer (CRC). Colonoscopy is the gold standard in the evaluation of the colon for colorectal tumors, but may be incomplete due to tumor obstruction, which is a frequent event in distal cancers. Double-contrast barium enema has a lower accuracy and is not ideal in the presence of signs of obstruction. In theory, intraoperative colonoscopy is a valid alternative, but its routine use is impeded by various practical limitations. Preoperative survey of the colon in 521 consecutive patients treated for CRC in our department was based on colonoscopy (92.5%). Our series was characterised by a high percentage of distal lesions (76.4%) and therefore by a high percentage of incomplete preoperative colonoscopies (50.4%) due to tumor obstruction. In the presence of an incomplete preoperative colonoscopy, we evaluated the entire colon with a double-contrast barium enema in selected cases (36.7%) and with a postoperative colonoscopy within 3 months of surgery in almost all patients (93.4%). The overall rate of complete endoscopic evaluation, either pre- or postoperatively, was 96.7%. The incidence of adenomas was significantly higher in the preoperative examinations as compared to early postoperative colonoscopy. This means that in distal cancer the vast majority of polyps will be located in the distal colon and therefore included in a standard resection. Four patients (0.8%), required a second operation for treatment of a missed lesion (2 benign and 2 malignant). The need for a repeat surgery apparently did not affect the therapeutic results in these four patients. On the basis of our experience, intraoperative colonoscopy would not appear to be a mandatory procedure in all cases of incomplete preoperative evaluation of the colon. However, in the absence of prospective, randomised trials comparing intraoperative vs early postoperative colonoscopy, the dilemma as to the strategy of choice remains
— id: 90932, year: 2000, vol: 52, page: 103, stat: Journal Article,

Debate over the use of endorectal ultrasound following preoperative irradiation for rectal carcinoma
Zorcolo L; Pisano M; Capra F; Melis M; Marongiu L; Casula G
2000 ;6(Suppl):34-34, Ospedali d'Italia - chirurgia
— id: 90954, year: 2000, vol: 6, page: 34, stat: Journal Article,

[Recurrent esophageal obstruction by a foreign body: a case report and review of the literature]
Melis, M; Pisano, M; Zorcolo, L; Cabras, M; D'Alia, G; Scintu, F
1999 Nov-Dec;20(11-12):490-494, Giornale di chirurgia
The Authors report a clinical case of a patient endoscopically treated for recurrent oesophageal obstruction by a foreign body. A review of the recent medical literature confirms that immediate endoscopic treatment is the best approach in the oesophageal retention of foreign bodies
— id: 90933, year: 1999, vol: 20, page: 490, stat: Journal Article,

Colonic diverticular disease in young patients
Scintu F; Zorcolo L; Melis M; Marongiu L; Casula G
1999 ;21(5):244-247, Coloproctology
— id: 90953, year: 1999, vol: 21, page: 244, stat: Journal Article,

Levels of interleukins 1f0, 6 and 8 in inflammatory bowel disease
Marongiu L; Marongiu ME; Scintu F; Melis M; Casula G;
1998 ;11(3):186-189, Chirurgia
— id: 90952, year: 1998, vol: 11, page: 186, stat: Journal Article,

[Lithiasis of the vermiform appendix. Remarks on a clinical case]
Melis, M V; Scintu, F
1998 Jan-Feb;53(1-2):65-69, Minerva chirurgica
The authors present a case of a 36 year old male, admitted with a 3 year history of cramping abdominal pain, fever, and transient finding of a right lower quadrant mass. The abdominal roentgenogram revealed a large opacity located on the right side of the fifth lumbar segment. The patient underwent laparotomy: an enlarged appendix was removed. The specimen had 4 calculi completely obstructing the lumen of the appendix. The diameter of calculi were 0.5 (in 3 instances) and 3 cm. The case herein described is rather uncommon, due to: 1) the rarity of multiple appendiceal calculi; 2) the size of the larger stone; 3) the inconstant finding of right lower quadrant mass; 4) the non development of acute appendicitis. Differential diagnosis involved several diseases presenting with palpable mass of the lower quadrant of the abdomen and/or laminated densities at the plain abdominal roentgenogram
— id: 90934, year: 1998, vol: 53, page: 65, stat: Journal Article,

Prognostic significance of proetein p53 in cells from colorectal cancer
Scintu F; Melis M; Dessy E; De Seta W; Casula G
1997 ;10(6):460-465, Chirurgia
— id: 90951, year: 1997, vol: 10, page: 460, stat: Journal Article,