Surgical Oncology

Quality assurance and cost effectiveness of clinical pathways for melanoma and sarcoma care.

Clinical pathways, based on minimum standard of care, are essential to standardize the clinical approach to tumors and make a health care system sustainable.

In melanoma treatment the use of Quality Assurance (QA) measures is less established than for other tumors, and sustainability is now threaten by the rapid progress of systemic treatments burdened by high cost. In Europe, an international project to promote QA of care was  proposed (COST action). In Italy,  minimum standards and QA parameters for  surgical treatment have been established, and auditing is ongoing. In Veneto, cost-effectiveness evaluation of the clinical pathway is going to be undertaken, in order to improve sustainability.

Evaluation of diagnostic performance in soft tissue sarcomas (STS) shows an overall full concordance among pathologists around 50%. Moreover, adherence to clinical practice guidelines has a positive impact on patients’ survival. These findings were functional to set-up the  implementation of a clinical pathway for STS in Veneto. In perspective, a QA program, based on a pre-defined list of indicators, will be undertaken.

Locoregional treatments for locally advanced tumors.
Our group is actively involved in clinical and translational studies on locoregional therapies such as isolated limb perfusion (ILP, for the treatment of locally advanced melanoma and limb threatening soft tissue sarcomas), hyperthemic intraperitoneal intraoperative chemotherapy (HIPEC, which is used in combination with optinal cytoreductive surgery for the treatment of peritoneal tumors such as peritoneal mesothelioma, pseudomyxoma peritonei, and peritoneal carcinomatosis from colorectal and ovarian cancers), and electrochemotherapy (ECT, for the treatment of  patients with skin tumors [primary or metastatic], with particular reference to malignant melanoma, basal cell carcinoma, squamous cell carcinoma, breast cancer, and soft tissue sarcoma).

Predictive and prognostic biomarkers in oncology.
Somatic (primary or metastatic tumor) as well as germline (e.g. single nucleotide polymorphisms, SNP) molecular markers can be used to define the probability to develop cancer, to respond to treatment, to carry minimal residual disease and to survive after apparently radical surgery. We apply these key principles to patients with cutaneous melanoma, soft tissue sarcomas as well as peritoneal tumors (including peritoneal mesothelioma, pseudomyxoma peritonei, and peritoneal carcinomatosis from colorectal and ovarian carcinomas). The main laboratory methods are quantitative real time PCR and immunohistochemistry. The final aim is to create multivariable models predicting the risk of interest on an individual basis (which can be often implemented in the clinical setting in the form of nomograms) according to the principles of personalized oncology (currently also known as precision oncology).  

5 Publications
Rossi CR, Sommariva A, Bastiaannet E, Van De Velde CJH.
Quality assurance and sustainability of cancer care: A European network is needed.
Eur J Surg Oncol. 2018 Apr;44(4):383-385
Pasquali S, Sommariva A, Spillane AJ, Bilimoria KY, Rossi CR.
Measuring the quality of melanoma surgery - Highlighting issues with standardization and quality assurance of care in surgical oncology.
Eur J Surg Oncol. 2017 Mar;43(3):561-571
Benna C, Simioni A, Pasquali S, De Boni D, Rajendran S, Spiro G, Colombo C, Virgone C, DuBois SG, Gronchi A, Rossi CR, Mocellin S.
Genetic susceptibility to bone and soft tissue sarcomas: a field synopsis and meta-analysis.
Oncotarget. 2018 Apr 6;9(26):18607-18626
Mocellin S, Tropea S, Benna C, Rossi CR.
Circadian pathway genetic variation and cancer risk: evidence from genome-wide association studies.
BMC Med. 2018 Feb 19;16(1):20
Campana LG, Testori A, Curatolo P, Quaglino P, Mocellin S, Framarini M, Borgognoni L, Ascierto PA, Mozzillo N, Guida M, Bucher S, Rotunno R, Marenco F, De Salvo GL, De Paoli A, Rossi CR, Bonadies A.
Treatment efficacy with electrochemotherapy: A multi-institutional prospective observational study on 376 patients with superficial tumors.
Eur J Surg Oncol. 2016 Dec;42(12):1914-1923

Funding  (last five years)

Private donations

350,000 €

Clinical trials

115,000 €

Institutional funding

1,250,000 €

People involved:
Simone Mocellin (full professor of surgery)
Marco Rastrelli (assistant professor)
Luigi Dall'olmo (assistant professor)

Group members:
Antonella Vecchiato (surgeon, IOV-IRCCS of Padova), Saveria Tropea (surgeon, IOV-IRCCS of Padova), Francesco Russano (surgeon, IOV-IRCCS of Padova), Marco Mazza (surgeon, IOV-IRCCS of Padova), Alessandra Buja (epidemiologist, University of Padova), Clara Benna (biologist, University of Padova), Romina Spina (case manager, IOV-IRCCS of Padova), Paolo del Fiore (data manager, IOV-IRCCS of Padova)