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Advanced Gastrointestinal and Sarcoma Surgical Oncology (AGISSO)

Epidemiology of peritoneal-based malignancies and their treatment:

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in selected patients with peritoneal carcinomatosis. We have performed close to 200 HIPEC procedures thus far, which is the largest known experience in Asia. Our own institution's analysis has statistically shown that CRS and HIPEC be safely carried out in Asian patients with peritoneal carcinomatosis from ovarian, colorectal, appendiceal, mesothelioma, and primary peritoneal origins. Our research revolves around identifying the prognostic factors that determine the outcomes, as well as quality of life (QOL studies) and cost-benefit analysis. In addition, we have a basic science team working on the genetic profile of peritoneal tumours, identifying prognostic markers, carcinogenic pathways and novel therapeutic targets that can be used for peritoneal metastases from gastric and colorectal as well as of ovarian and primary peritoneal origin. We study the molecular profiles of peritoneal carcinomatosis from different tumour histological types to examine if there is any commonality between them and to identify potential biomarkers and therapeutic targets. Similarly, our postulation is that mucinous tumours of colorectal and ovarian origins share some characteristics in their profiles. We are also working, in collaboration with other researchers and clinicians, on the establishment of cell-line and xenograft models to better understand the biology of disease.

Multidisciplinary management of sarcomas:

We are looking at clinical studies on our cohort of sarcoma patients and have published on our national centre’s experience with this diverse group of diseases. We have recently concluded a retrospective analysis which looked at validating the MSKCC prognostic nomogram and comparing it with other nomograms in terms of their predictive accuracy. We also collaborate with Prof Teh Bin Tean on the molecular profiling of these cancers. Our current project seeks to determine the molecular signatures of well and de-differentiated liposarcomas that may allow us to determine the pathway of progressive dedifferentiation.

The GIST of the gastrointestinal stromal tumour project:

GISTs despite complete cytoreduction, are associated with a 50% recurrence rate in 2 years. In trying to understand the biology of this disease, we collaborate with the medical oncologists and scientists to determine the molecular markers of relevance in GIST. In addition, our team has looked into the prospects of upfront surgery for the recurrent patient, as well as, the role and significance of multivisceral resection in patients with locally advanced GIST.

Surgical management of melanomas:

Our institution has a fairly extensive experience with melanomas. Our studies include evaluating the prevalence of various histological types of melanoma presenting to our Asian society, trying to distinguish the difference between these melanomas with those that are more commonly seen in the Western population, and the role of surgical management of melanoma. One of the studies evaluates the extent of nodal dissection in patients with advanced lower limb melanomas with clinically palpable inguinal nodes. We seek to identify the clinicopathological or radiological factors that predict for pelvic nodal disease. We are currently also looking at our experience with isolated limb perfusion and reviewing the international literature on this topic.

Multidisciplinary approach to pelvic tumours & Gastrointestinal cancers:

Pelvic tumours often comprise cancers with colorectal, gynaecological and urological origins. Most of these locally advanced tumours require the collaboration of multi-disciplinary teams and multivisceral resection of involved organs. Our studies evaluate the survival benefits of this aggressive surgical approach and identify the prognostic factors in these patients. We have also embarked on multi-institutional QOL studies for these patients.

Quality of life studies in peritoneal and pelvic cancers:

Prospective Quality of Life studies are ongoing for our peritoneal and pelvic cancer patients, and are carried out in 4 stages- pre-operative, 3 months, 6 as well as 12 months post-operative. The results of a QOL would greatly benefit the proposal of CRS & HIPEC, as well as pelvic exenterations as it helps allay concerns regarding quality of life deterioration post aggressive surgical therapy. Our studies show that our patients report a higher quality of life compared to outpatient cancer patients. We will continue to prospectively monitor our HIPEC as well as pelvic oncology patients up till 1 year post-surgery.