Gastrointestinal Surgery

The Unit of Gastrointestinal Surgery at San Raffaele is one of the leading Unit in Italy for advanced minimally invasive treatment of digestive system diseases. In particular it is one of the highest volume centers in Italy for Upper and Lower GI cancer treatment.  

Cancer of the esophagus and esophagogastric junction is treated with a case load of approximately 80 patients per year with the most advanced multidisciplinary approach consisting of neo-adjuvant chemo or chemoradiation protocols.   Hybrid (laparoscopy and thoracotomy) or totally minimally invasive (laparoscopy and thoracoscopy) esophagectomy are routinely performed with an experience with these techniques of more than 20 years.   Cancer of the stomach is treated according the most recent guidelines and most advanced protocols of neoadjuvant chemotherapy and surgery with extended nodal dissection.   Minimally invasive gastrectomies are performed according to the stage of the disease.   Colorectal cancer is routinely treated in more than 80% of cases with minimally invasive surgery. As for treatment of non-neoplastic diseases minimally invasive access is used for bariatric and metabolic surgery, endocrine surgery, colectomies for inflammatory and benign bowel diseases, surgery of the gallbladder and biliary tree, repair of abdominal wall defects. The Unit leads the surgical activity of the strategic program of kidney and pancreas transplant.   ERAS (Enhanced Recovery After Surgery) programs and standardized perioperative pathways are applied for cases management. Our organization obtain in a short time a thorough diagnosis and staging of diseases with MDT weekly meetings to agree on personalized treatment plans.

Main conditions treated

  • Cancer of the esophagus and esophagogastric junction including Barrett cancer (over 80 esophagectomies per year using minimally invasive access)
  • Cancer of the stomach (over 80 cases per year)
  • Cancer of the colon and rectum (approximately 300 cases per year)
  • Esophageal diverticula (including transoral treatment of Zenker and laparoscopic treatment of epiphrenic diverticula)
  • Esophageal achalasia
  • Reflux disease and hiatal hernia
  • Inflammatory bowel disease and colonic diverticulitis
  • Cancer or adenomas of the adrenal glands (minimally invasive adrenalectomy)
  • Haematologic conditions (lymphoma etc. with minimally invasive splenectomy)
  • Stones of the gallbladder or the main bile duct
  • Ventral or inguinal hernia repair

Research

Blausen_0316_DigestiveSystemThe unit is involved in clinical trials mainly on treatment of cancer of the esophagus and stomach, especially on neoadjuvant treatments modalities.   Also, in the domain of personalized targeted therapy, new means of molecular profiling of cancer cells are under study in order to try to identify patients that will respond to preoperative chemoradiation on the basis of genomic changes in the tissue at the index biopsy.   New perioperative treatment pathways are under investigation as well. Colonic cancer is under study for different surgical techniques and new minimally invasive approaches.

Technology

A fully equipped operating room is available for the Unit with six 8.00 a.m. to 8.00 p.m. slots per week.   Last generation high definition 3D and high definition 2D with Infra-Red technology (for intraoperative ICG evaluation of organs vascularization) minimally invasive racks are normally used.   Last generation ultrasounds or radiofrequency tissue sealing energy devices are available as all kind of mechanical suturing devices.   Soon robotic surgery with Da Vinci Xi will be available.

Staff

rosati_okRiccardo Rosati MD, FACS is Head of the Department and Professor of Surgery at Vita-Salute University School of Medicine. Members of the staff are:

Ugo Elmore (Minimally Invasive Surgery),
Paolo Parise (Upper GI Surgery),
Carlo Socci (Bariatric/Metabolic and Transplant),
Danilo Carlo Parolini(Abdominal wall defects and Transplant),
Andrea Vignali (Inflammatory Bowel Diseases),
Paola De Nardi (Pelvic Unit and Proctology),
Andrea Tamburini (Proctology),
Alessandra Melis (Esophageal diseases),
Andrea Cossu (Colorectal),
Davide Poldi (Esophageal disease),
Paolo Gazzetta (Bariatric/Metabolic and Transplant),
Massimiliano Bissolati (Bariatric/Metabolic and Transplant).