Clinical Research

My major interest in research is within the field of hepatobiliary and pancreatic disorders.

Clinical Research

Pancreatic Resection Techniques

Interested in methods of reducing the incidence of pancreatic fistula and techniques that reduce rates of delayed gastric emptying (Publication 42).Completed prospective study in examining the impact of Braun entero-enterotomy on delayed gastric emptying and pancreatic fistula (Publication 75).

Outcomes of Pancreaticoduodenectomy

Major interest in surgical outcomes of pancreaticoduodenectomy, in particular more advanced resections including additional organs and major venous resection (Publication 44, 45, 46, 92). Also interested in fast-track surgery after major pancreatic surgery.Compared fast-track surgery technique with standard techniques (Publication 76 and 83).

Pancreatic Cancer Treatment

Involved in a national study reviewing the outcomes of patients treated with borderline resectablepancreatic cancer.I am collaborating with oncology colleagues examining the role of gemcitabine combined with Abraxane for the treatment of pancreatic adenocarcinoma in a neoadjuvant and more recently adjuvant setting. I am also collaborating in a study assessing circulating tumour DNA as a marker of resectable pancreatic cancer, with colleagues at Royal Melbourne Hospital and Peter McCallum Cancer Center.

Screening for Pancreatic Cancer

Currently the lead investigator in Victoria of a pancreatic cancer screening program to screen individuals considered high risk for developing pancreatic cancer. This is in collaboration with colleagues at St Vincent’s Hospital (NSW) and the Gavan Institute (NSW).

Also, recently examined the association of diabetes and pancreatic cancer by meta-analysis. The study suggested that there may be a role for screening some patients with newly diagnosed diabetes for pancreatic cancer (Publication 91).

Postoperative Fluid Management

Collaborative work is being undertaken with the Department of Anaesthesia to determine optimal fluid management regimens in patients undergoing major liver and pancreas surgery (Publication 94).

Acute Pancreatitis

The impact of hyperbaric oxygen therapy on patients with severe necrotizing pancreatitis is being assessed. Apilot study was conducted.Treatment appears safe and may reduce disease severity when administered early following initial hospital presentation. (Publication 19).

Peri-Ampullary Tumours

Research has been conducted into treatment outcomes for peri-ampullarytumours. Particular focus is on the treatment outcomes for patients with ampullary adenocarcinomas. The potential role of local surgical therapies for these tumours is a subject of continuing research. (Publication 1)

Research in outcomes of patients with neuroendocrine pancreatic tumors conducted. Review of a large series of patients with pancreatic insulinomas treated at the Massachusetts general hospital and factors determining disease free recurrence was completed (Publication 34).

Colorectal Liver Metastases

Research into the long term survival of patients with unresectable colorectal liver metastases by laser thermotherapy has been conducted. In the initial series of 80 patients, treatment by laser thermotherapy improved survival, compared to the natural history of untreated disease. (Publication 15) A continuing prospective study is in progress.

Research into survival outcomes of patients in the era of effective chemotherapies and aggressive surgery has also been performed and is continuing (Publication 41).

Gallstones

Management of choledocholithiasis is an area of interest. A prospective study of selective endoscopic retrograde cholangiography in 427 patients with cholelithiasis was conducted. (Publication 14) The role of routine intra-operative cholangiography for the management of uncomplicated cholelithiasis is an area of continuing research. Assessment of outcomes of acute cholecystitis according the severity (Publication 66), age (Submitted) and gender (Publication 74) completed.

Endoscopic Retrograde Cholangiopancreatography

Prospective study of the effects of double wire cannulation on biliary cannulation success rates completed (Publication 82). Outcomes of metallic stenting for palliation of peri-ampullary malignancy published (Publication 69).

Post-Operative Pain Management

Interested in methods to reduce post-operative pain particularly following laparoscopic procedures. Participated in a randomized control trial that examined the efficacy of a depot long acting anaesthetic (Saber Bupivicaine)

Wound Infections

I am in interested in methods to reduce surgical site infection, in particular the role of pressurized irrigation devices to reduce wound infections (Publication 47). I am the principle investigator of a recently completed randomized trail assessing the impact of pulse irrigation on wound infections at the Austin and Warringal hospitals.

Diaphragm Pacing Stimulation

I am currently the only surgeon in Australasia that performs diaphragm pacing surgery for spinal cord injury and involved in research in this field (Publication 56 & 61). More recently the diaphragm pacing has been used selectively to prolong and improve quality of life in some patients with motor neurone disease (Publication 98).

Basic Research

Pancreas Cancer

A metastatic pancreatic cancer model using murine cells has been characterised in our laboratory (Publication 87). Studies are progress examining the role of P-21 Activated Kinases (PAKs) tin the treatment of pancreatic cancer. Pancreatic cancer develops as a result of a series of genetic mutations, and progresses from non- invasive tumours to invasive and metastatic cancers. The most frequent mutation, observed in more than 95% of cases, involve the K-Ras gene. The product of the K-Ras gene is a protein of 21 kDa (p21), which binds to and activates PAKs. The PAK family of serine/threonine kinases are not only important in carcinogenesis, but are also major regulators of cytoskeletal dynamics, with significant roles in cell proliferation and motility. PAKs are therefore an attractive therapeutic target, as PAK inhibitors should simultaneously block multiple pathways. We have for the first time published that reduction of PAK activity using a non-selective PAK inhibitor increases the sensitivity of PDAC to gemcitabine chemotherapy in vitro and in vivo (Publication 90). Ongoing studies are in progress to examine the role of PAKs (particularly PAK1 and PAK4) in the development, growth, chemosensitivity and survival of pancreatic cancer. This work is the subject of future major grant applications. . We plan to perform in vitro and in vivo studies with selective PAK1 and PAK4 inhibitors. In addition, as tumour-stroma interactions are extremely important in the development and progression of pancreatic cancer, these will be examined by utilisation of unique PAK knock-out murine models. The studies proposed in this application will elucidate the effects of targeting individual PAKs on the development and growth of pancreatic cancer, and may lead to the development of improved drug treatments. We are also collaborating the Garvan Institute NSW to look at the role of PAKs in the development of pancreatic cancer.

I have continuing involvement with pancreas cancer research in Australia, being a member of the Australian Pancreatic Cancer Genome Initiative (APCGI). Several pivotal publications have arisen form this collaborative effort (Publications 78,79,80,102)

Acute Pancreatitis

A rat model of acute severe pancreatitis was developed and characterized. The histological features of disease in this model are similar to the human situation. This involves retrograde injection of 4% Sodium Taurocholate into the biliopancreatic duct, under controlled pressure, to produce severe necrotizing pancreatitis. This model has been used to assess the effects of various therapies on the development of severe acute pancreatitis.

Hyperbaric Oxygen Therapy for the Treatment of Acute Severe Pancreatitis. Preliminary studies have been conducted into the potential use of hyperbaric oxygen (HBO) therapy to reduce the severity of severe acute pancreatitis. Compared to control animals with severe acute pancreatitis, HBO therapy appears to decrease pancreatitis severity and improve survival. Several studies have been completed and published.

Colorectal Liver Metastases

A mouse model of colorectal liver metastases has been used to research different treatment strategies for colorectal liver metastases. The model involves intrasplenic injection of a mouse derived colon cancer tumour line to induce liver metastases in CBA strain mice. The model closely resembles the human situation and has been characterized in terms of tumour growth patterns, blood vessel characteristics, histology and expression of various angiogenic markers. Direct comparisons to human colorectal liver metastases, in terms of histology and microvasculature have been undertaken. (Publication 11).

Interstitial Laser Thermotherapy of Liver Tumours. There is growing interest in the use of thermal ablation for the treatment of liver tumours. The mechanisms of tumour ablation by laser thermotherapy have been investigated in the previously described murine model of colorectal liver metastases. This has involved assessment of tumour injury following laser application by histology, immunohistochemistry and histochemical vital staining techniques. The effect of therapy on tumour microvasculature has been assessed by Laser Doppler Flowmetry, Scanning Electron Microscopy, Confocal in-vivo microscopy and oxygen fluorescence quenching techniques. The role of blood flow occlusion in the patterns of laser injury has been investigated. In addition, potential tumour growth promoting effects of thermal injury has been demonstrated. (Publications 4, 11, 12, 17, 20, 23, 24, 26-28)

Vascular Targeting of Colorectal Liver Tumours. The importance of tumour blood flow to the development of colorectal liver metastases and as a potential target for therapeutic interventions is a major research focus. The effect of thalidomide, as an anti-angiogenic agent, on the growth of colorectal liver metastases has been investigated. (Publications 22) Minor growth reducing effects have been shown. Several anti-tubulin binding agents that target intact tumour vasculature have been investigated and are under continuing research. These include Combretastatin A4 Phosphate Prodrug (Combretastatin A4P) and its derivatives and a recently developed agent, CYT997, showing major anti-tumour effects. In addition, macromolecular chemotherapeutic agents that are retained in tumours due the leakiness of tumour vessels and enhanced retention (Enhanced Permeability and Retention effect) have been investigated.

Reactive Oxygen Species Generation and Hyperbaric Oxygen Therapy. The potential synergistic use of reactive oxygen species (ROS) producing chemotherapeutics (SMA- Pirarubicin) and hyperbaric oxygen (HBO) therapy has been investigated for the treatment of colorectal liver metastases, with promising results. Further studies into the effects of ROS and HBO on turmour growth are in progress.

Liver Regeneration and Tumour Growth. A novel technique of liver resection in mice was developed and used to asses the effects of liver regeneration on the growth of colorectal liver metastases. (Publication 16) Following major liver resection growth promoting effects have been demonstrated, including increased incidence of extrahepatic tumour spread. The mechanisms involved in the growth promoting effects are under investigation.

Ischameia Perfusion Study

Currently involved in a study examining the neuronal changes that occur as result of small bowel ischaemia utilizing human tissues obtained at the time of major pancreatic surgery. The role of nitric Oxide in enteric ischemic damage is being assessed.

Thesis Summary

"The Effect of Laser Induced Thermal Ablation on Liver Tumours"
Doctorate of Philosophy by Thesis, University of Melbourne

Background

Laser thermal ablation (LTA) is an in situ ablative technique that induces heat destruction of liver tumours. Despite increasing clinical use of LTA, reports of long-term outcomes and limitation of treatment in specific cohorts of patients with liver tumours are lacking. In addition, the mechanisms of action of therapy have not been fully elucidated.

This study highlights the long-term clinical results and limitations of LTA in the treatment of a cohort of patients with unresectable colorectal liver metastases and examines the mechanisms of action thermal ablative injury in a murine model.

Methods

In 80 patients with unresectable colorectal cancer (CRC) liver metastases treated by LTA using Nd-YAG laser (wavelength 1064 nm) with ultrasound real-time monitoring, long-term treatment efficacy was assessed. Patients were selected based on the following criteria: (1) Disease confined to the liver (2) Unsuitable for complete surgical resection due to anatomical location of tumours or the extent of hepatic involvement (3) Maximum of five tumours and (4) Tumour diameter not exceeding 10 cm.

The mechanism of thermal ablative injury was assessed in a murine model of colorectal liver metastases. Laser (2 Watts for 50 seconds) was applied to the liver and tumours in CBA strain mice. Tissue injury was assessed at varying time points ranging from immediately following injury to 21 days thereafter. The extent of thermal injury was assessed histochemically by a vital stain for nicotinamide adenine dinucleotide (NADH) diaphorase. Tissue sections were also studied by immunohistochemistry for apoptosis, Kupffer cell response and heat shock protein 70 (HSP 70) expression. Microvascular damage was assessed at various time points by scanning electron microscopy, Laser Doppler flowmetry and confocal in-vivo microscopy.

Potential growth promoting effects of laser therapy on micrometastases was assessed following 30% liver volume ablation in animals bearing microscopic colorectal liver metastases. The volume of tumour growth in the regenerating ablated liver lobe was compared to untreated lobes and controls by tumour stereology. Tumour proliferation was determined by immunohistochemistry for Ki67 antigen. The effect of thermal ablation was assessed in a separate group of animals on the induction of angiogenic factors, Vascular endothelial Growth factor (VEGF), Fibroblast growth factor (FGF), and Transforming Growth factor B (TGF beta) was assessed by immunohistochemistry.

Results

In our clinical study of 80 patients, 168 liver tumours were treated by LTA with a median diameter of 5 cm (range 1 – 10 cm) without any procedure related deaths. The overall complication rate was 16%, with all cases managed conservatively. Complete tumour ablation was achieved in 67% of patients. Sixty-seven deaths occurred and were related to hepatic recurrences in 55 cases, extrahepatic disease in 9 patients and unrelated to malignancy in 3 others. The median survival of patients treated by LTA was 35 months, with a 5-year survival of 6.7%.

Thermal ablation produces direct lethal thermal injury followed by indirect progressive tissue damage beyond the initial thermal effects. Normal liver and tumour tissue respond differently to thermal ablation. In tumour tissue the direct injury is more pronounced, while the progression of injury is more rapid and extensive in liver. In liver, the peak volume of necrosis occurred at 3 days, while in tumour tissue the peak was at 4.5 days.

Increased apoptotic response was noted at 12 hours following thermal injury and remained elevated until 72 hours in tumour tissue. HSP 70 expression was most pronounced in tumour tissue and remained elevated for 72 hours following therapy. Stimulation of Kupffer cell activity occurred in both liver and tumour tissue. The increase in Kupffer cell activity is earlier and greater in liver tissue. Progressive microvascular injury was observed following thermal ablation in both liver and tumour tissue and at times preceded the tissue injury.

In animals with micrometastases, 30% ablation of liver volume by laser produced an increase in percentage of tumours in the regenerating lobe, without an overall increase in tumour load or extrahepatic spread. Following thermal ablation, there was increased local expression of VEGF and FGF in liver and increased expression of VEGF, FGF and TGF in tumour adjacent to the treatment site.

Conclusion

Overall, treatment of selected patients with liver tumours by LTA appears to achieve long-term survival. There is however a high incidence of local tumour recurrence due to incomplete tumour destruction and regional and extrahepatic tumour recurrences. Thermal ablation by laser produces direct injury followed by indirect effects that results in progressive tissue damage and involves interplay of several factors. Thermal ablation by laser appears to have local tumour promoting effects, possibly related to increased induction of several angiogenic factors. Manipulation of the processes involved in laser induced tumour destruction may further ensure complete tumour destruction and reduce local and distal recurrences.

Research Grants

Awarded by Peer Review

Surgeon Scientist Scholarship 2002–2004 – Royal Australasian College of Surgeons
"Treatment of liver tumours"
Nikfarjam M

Equity Trustees - Harold Brennen Foundation 2003
"Treatment of liver tumours by focal hyperthermia"
Christophi C, Nikfarjam M

Jack Brockhoff Foundation 2003
"Treatment of liver tumours"
Christophi C, Nikfarjam M

Austin Hospital Medical Research Foundation 2004
"Hyperbaric oxygen therapy for the treatment of severe pancreatitis"
Christophi C, Nikfarjam M

Astra Zenica Project Grant 2005
"The mechanisms of focal hyperthermia on colorectal cancer liver metastases"
Christophi C, Nikfarjam M

University of Melbourne Research Grant 2005
"Treatment of liver tumours by thermal ablation"
Christophi C, Muralidharan V, Shulkes A, Nikfarjam M

University of Melbourne Research Grant 2006
"Hyperbaric oxygen therapy for the treatment of acute severe pancreatitis"
Christophi C, Millar I, Muralidharan V, Shulkes A, Nikfarjam M

Anti-cancer Council of Australia Project Grant 2006
"Treatment of liver tumours by thermal ablation"
Christophi C, Muralidharan V, Shulkes A, Nikfarjam M

Early Career Grant – University of Melbourne 2010
“Wound Irrigation Study”
Nikfarjam M

Austin Research Medical Foundation – Austin Health 2012
“Role of PAK in pancreatic cancer"
Nikfarjam M

Austin Research Medical Foundation – Austin Health 2013
“Role of P21-activated kinases (PAK)  in determining sensitivity of pancreatic carcinoma to gemcitabine chemotherapy”
Nikfarjam M  $18,000

Presentations

International

  1. "SMA-Pirarubicin and combined with hyperbaric oxygen therapy for the treatment of colorectal liver metastases". Undersea and hyperbaric medicine conference, Sydney, Australia 2004 Millar I, Nikfarjam M, Christiophi C
  2. "A new miceller anticancer drug: In vivo and in vitro evaluation of SMA-Pirarubicin micelles". Controlled release annual society meeting, USA 2004 Maeda H, Greish K, Nikfarjam M, Christophi C
  3. "Improved Survival following interstitial laser thermotherapy for the treatment of unrespectable colorectal liver metastases". AASLD, Boston, USA 2004 Nikfarjam M, Christophi C
  4. "Mechanisms of liver tumour ablation by focal hyperthermia". AASLD, Boston, USA 2004 Nikfarjam M, Christophi C
  5. Thalidomide for the treatment of colorectal liver metastases. AGW, Brisbane, Australia 2004 Darawalla J, Nikfarjam M, Christophi C
  6. "Oxi4503 for the treatment of colorectal liver metastases". AGW, Brisbane, Australia 2004 Malcontenti-Wilson C, Nikfarjam M, Christophi C
  7. "Altered patterns of tumoUr growth following focal hyperthermia". DDW, Chicago, USA 2005 Nikfarjam M, Christophi C
  8. "Hyperbaric oxygen reduces morbidity and mortality in severe acute pancreatitis". International Conference on Diving and Hyperbaric Medicine, Barcelona, USA 2005 Millar I, Nikfarjam M, Christophi C
  9. "Improved Contemporary Surgical Management of Insulinomas: A 25-year Experience at the Massachusetts General Hospital.". American Pancreatic Association, USA 2007 Nikfarjam M, Warshaw AL, Axelrod, L, Deshpande V, Thayer SP, Ferrone CR, Fernández-del Castillo C
  10. "Immunologic ignorance and tolerance both play a role in hepatic tumourigenesis" Digestive Diseases Week, USA 2008, Avella D, Nikfarjam M …. Staveley-O’Carroll
  11. " Surgical outcomes of patients with gastrointestinal stromal tumours in the era of target drug therapy" Digestive Diseases Week, USA 2008, Nikfarjam M …. Staveley-O’Carroll
  12. "Alloderm Mesh: An Innovative Tool for Diaphragmatic Reconstruction in Patients with large retroperitoneal Sarcomas". Association for Academic Surgery (AAS). 3rd Annual Academic Surgical Congress. 2008. Huntington Beach. CA. Avella D, Nikfarjam M……. Staveley-O’Carroll
  13. "Surgical Management of Liver Metastasis" Advaces in the Management of Colorectal Cancer (Invited lecture). Colorectal Cancer Symposium, Pennsylvania 2008. Nikfarjam M
  14. "Magnetic resonance imaging is a powerful tool for characterizing the impact of radiofrequency ablation in a murine model of spontaneous hepatocellular cancer" AHBPA 2008 Shereef S. Nikfarjam M. ……. Staveley-O’Carroll
  15. "Combined pancreaticoduodenectomy and right hemicolectomy - Outcomes and Indications". American Pancreatic Association, USA 2008 Kimchi E. Nikfarjam M, …. Staveley-O’Carroll KF
  16. "Reduced Delayed Gastric Emptying with Non-pylorus Preserving Pancreaticoduodenectomy and Antecolic Gastrojejunal Anastomosis" American Pancreatic Association, USA 2008 Gusani NF, Nikfarjam M, …. Staveley-O’Carroll KF
  17. "Reduction of surgical site infections by use of pulsatile lavage irrigation device after prolonged intra-abdominal operative procedures ". Annual Academic Surgical Congress 2009. Nikfarjam M... Staveley-O’Carroll. (Accepted for presentation)
  18. "The Diagnostic Efficacy of Natural Orifice Endoscopic Surgery (NOTES): Is there a Role in the Intensive Care Unit? SAGES 2009 Trunzo, J. Nikfarjam M….. Marks JM
  19. "Examination of the Local Inflammatory Response of NOTES (Natural Orifice Translumenal Endoscopic Surgery) Versus Laparoscopy Utilizing Both Carbon Dioxide and Room Air in a Porcine Model" SAGES 2009 Trunzo, J. Nikfarjam M….. Marks JM
  20. "Pancreaticoduodenectomy in patients with a history of Roux-en Y gastric bypass surgery" Pancreas Club 2009 Nikfarjam M, … Hardcare J
  21. "Additional organ resection combined with pancreaticoduodenectomy does not increase post-operative morbidity and mortality". AHPBA 2009 Nikfarjam M,…. Staveley-O’Carroll KF
  22. "Peri-pancreatic Castleman’s disease" Annual Academic Surgical Congress 2009 Shereef S, Nikfarjam M….. Staveley-O’Carroll KF
  23. “The effect of surgical volume and the provision of residency and fellowship training on complications of major hepatic resection” AHPBA/IHPBA Argentina 2010 Nikfarjam M and Kohn G.
  24. “Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis” DDW USA 2011
  25. Management of duodenal diverticulum. APHPBA Australia 2011 (Invited talk)
  26. Laparoscopic distal pancreatectomy. APHPBA Australia 2011 (Invited talk)
  27. Update in NOTES cholecystectomy. APHPBA Australia 2011 (Invited talk)
  28. Laparoscopic ligation of common hepatic artery to precondition liver and stomach prior to radical distal pancreatectomy and splenectomy with enbloc resection of the celiac axis for locally advanced pancreatic body/ tail tumors APHPBA Australia 2011 Houli N & Nikfarjam M
  29. Fluid sparing regimens in surgery Perioperative medicine Conference - ANZCA annual meeting, NSW Australia 2012 (Invited talk)
  30. Fast track recovery following pancreaticoduodectomy. Australia and New Zealand pancreas club, SA Australia 2012
  31. A novel p21-activated kinase 1 inhibitor, Glaucarubinone, combined with Gemcitabine synergistically inhibits the growth of pancreatic ductal adenocarcinoma. Pancreas Club,  Orldando, Florida, USA 2013
  32. Advances in Pancreatic surgery (invited talk)  Australasian Pancreas Club, Melbourne, Victoria Australia 2013
  33. Association of Diabetes Mellitus and Pancreatic Adenocarcinoma -
    A Meta-analysis of 86 Studies. Australasian Pancreas Club, Melbourne, Victoria Australia 2013
  34. Potential role of PAK4 in treatment of pancreatic cancer Australasian Pancreas Club, Melbourne, Victoria, Australia 2013
  35. Glaucorubinone for the treatment of pancreatic ductal adenocarcinoma Australasian Pancreas Club, Melbourne, Victoria Australia 2013
  36. A multicentre randomized double-blind controlled non-inferiority multicentre study of Plasmalyte vs. Compound Lactate Solution in patients undergoing liver resection. Australian & New Zealand College of Anaesthetists Annual Scientific Meeting, Melbourne, Victoria, Australia 2013
  37. Analgesia practice for pancreaticoduodenectomy (Whipple’s Procedure): Is it time to reconsider epidurals?  Australian & New Zealand College of Anaesthetists Annual Scientific Meeting, Melbourne, Victoria, Australia 2013
  38. Enhanced Recovery After Surgery Program Reduces Length of Stay Following Uncomplicated Pancreaticoduodenectomy.  Australian & New Zealand College of Anaesthetists Annual Scientific Meeting, Melbourne, Victoria, Australia 2013
  39. Liberal fluid intervention and positive fluid balance affect length of hospital stay following  pancreaticoduodenectomy Australian & New Zealand College of Anaesthetists Annual Scientific Meeting, Melbourne, Victoria, Australia 2013

National and State (Australian)

  1. "The role of local resection in the treatment of ampullary tumours of the duodenum". RACS Victorian Annual Scientific meeting, Shepperton Australia 2000 Nikfarjam M
  2. "The role of endoscopic ultrasound in the treatment of ampullary tumours of the duodenum". Cabrini Institute, Melbourne, Australia 2000 Nikfarjam M
  3. "Management of ampullary tumours". Gut Club, Melbourne, Australia 2002 Nikfarjam M
  4. "Progressive necrosis occurs independent of thermal effects following laser thermal ablation". Annual Scientific Meeting, Melbourne, Australia 2003 Nikfarjam M
  5. "SMA- Pirarubicin for the treatment of colorectal liver metastases". RACS Victorian Annual Scientific meeting, Bendigo, Australia 2004 Nikfarjam M
  6. "Hyperbaric Oxygen therapy for the treatment of acute severe pancreatitis". Cabrini Institute, Melbourne, Australia 2004 Nikfarjam M
  7. “NOTES in HPB Surgery” Langham Meeting, Melbourne, Australia 2009 (Invited Talk)
  8. “Career development – Training in the USA” – Victorian Scientific Meeting, Melbourne 2010 (Invited Talk)
  9. “Specialist Surgeon versus Generalist” Victorian Scientific Meeting, Melbourne 2010 (Invited Talk)
  10. “NOTES – A note of caution” Gut Club, Melbourne 2010 (Invited Talk)
  11. “Current management of colorectal liver metastases” Roche Medical, Melbourne 2010 (Invited talk)
  12. Management of pancreatic pseudocysts  3rd Annual Cook Medical Pancreatico-Biliary Workshop.  Sydney, NSW 2013 (invited talk)
  13. Cystic Tumours of the pancreas.  4th Annual Cook Medical Pancreatico-Biliary Workshop.  Sydney, NSW 2013 (invited talk)
  14. Pancreatic Neuroendocrine liver metastases – A management approach. Victorian endocrine meeting. St Vincent’s Hospital, Melbourne, Australia 2013 (invited talk)

Publications

  1. Nikfarjam M, Muralidharan V, McLean C, Christophi C. Local resection of ampullary adenocarcinomas of the duodenum. ANZ J Surg 2001;71:529-533.
  2. Nikfarjam M, Muralidharan V, Christophi C, Tang H, Clouston D. Autoimmune pancreatitis ANZ J Surg. 2002 Jun;72(6):450-2.
  3. Nikfarjam M, Mclean C, Muralidharan V, Christophi C. Neuroendocrine tumours of the Ampulla of Vater. ANZ Journal of Surgery, 2002 Jul;72(7):531-3.
  4. Muralidharan V, Nikfarjam M, Malcontenti-Wilson C, Christophi C Interstitial laser hyperthermia and the biological characteristics of tumour: study in a murine model of colorectal liver metastases. J Clin Laser Med Surg. 2003 Apr; 21(2): 75-83.
  5. Christophi C, Nikfarjam M, Muralidharan V, Dudley F. Bile duct cancer in HLA identical twins. Journal of Gastroenterology and Hepatology. 2003 Apr; 18(4): 469-72.
  6. Nikfarjam M, Evans P, Christophi C. Pancreatic resection for metastatic melanoma. HPBSurg 2003;3;174-179.
  7. Nightingale S, Nikfarjam M, Djeric M. Small bowel diverticulum complicated by perforation. ANZ Journal of Surgery 73 (10), 867-869.
  8. Nikfarjam M, Christophi C. Internal hernia traversing the lesser sac. Annals of Surgery of the Royal College of Hong Kong 2003 (4), 99-102.
  9. Nikfarjam M, Evans P, Muralidharan V, Christophi C. Hepatic carcinoid tumours - Review .HPBSurg 2004, vol. 6, issue. 1, 13-17.
  10. Nikfarjam M, Christophi C. Interstitial laser thermotherapy for liver tumours Br J Surg. 2003 Sep; 90(9): 1033-47. Review.
  11. Nikfarjam M, Muralidharan V, Malcontenti-Wilson C, Christophi C. Scanning electron microscopy study of the blood supply of human colorectal liver metastases. Eur J SurgOncol. 2003 Dec; 29(10): 856-61.
  12. Muralidharan V, Nikfarjam M, Malcontenti-Wilson C, Christophi C. Effect of interstitial laser hyperthermia in a murine model of colorectal liver metastases:scanning electron microscopic study. World J Surg. 2004 Jan; 28(1): 33-7.
  13. Nikfarjam M, Evans P, Muralidharan V, Christophi C. Not all hepatic carcinoids are metastases. J GastroenterolHepatol. 2004 Feb; 19(2): 232-3.
  14. Katz D, Nikfarjam M, Sfakiotaki A, Christophi C.Selective endoscopic cholangiography for the detection of common bile duct stones in patients with cholelithiasis. Endoscopy 2004 Dec;36(12):1045-9.
  15. Christophi C, Nikfarjam M, Muralidharan V. Long term Survival of Patients with Colorectal liver metastases treated by Interstitial Laser thermotherapy. World Journal of Surgery 2004 Oct;28(10):987-94.
  16. Nikfarjam M, Malcontenti-Wilson C, Fanartzis M, Daruwalla J, Christophi C. A model of partial hepatectomy in mice J. Invest. Surg. 2004 Sep-Oct;17(5):291-4.
  17. Nikfarjam M, Christophi C. Focal Hyperthermia Produces Progressive tumour Necrosis Independent of the Initial Thermal Effects. Journal of Gastrointestinal Surgery 2005 Mar;9(3):410-7.
  18. Cherk M, Nikfarjam M, Christophi C. Retroperitoneal lymphangioma. Asian Journal of surgery2006 Jan;29(1):51-4.
  19. Christophi C, Millar, I, Nikfarjam M, Muralidharan V. Hyperbaric Oxygen therapy of the treatment of acute severe pancreatitis. J of Gastroenterology and Hepatology2007 Nov;22(11):2042-6.
  20. Nikfarjam M, Christophi C A Comparison of 980 and 1064nm wavelength lasers for treatment of colorectal liver metastases. Photomedicine and laser surgery 2005 Jun;23(3):284-8.
  21. Nikfarjam M, Muralidharan V, Christophi C. Mechanisms of heat destruction of liver tumours. Journal of Surgical Research 2005 Aug;127(2):208-23.
  22. Darawalla J, Nikfarjam M., Malcontenti-Wilson C, Christophi C. The effect of thalidomide on colorectal liver metastases in a murine model. Journal of Surgical oncology. 2005 Aug 1;91(2):134-40.
  23. Nikfarjam M, Christophi C. A The apoptotic response of liver and colorectal liver metastases to focal hyperthermic injury Anticancer Research Mar-Apr;25(2B):1413-9.
  24. Nikfarjam M, Christophi C. Patterns of Heat Shock Protein (HSP 70) expression and Kupffer Cell activity following focal hyperthermia treatment of colorectal liver metastases Journal of Hyperthermia 2005 Jun;21(4):319-32.
  25. Nikfarjam M, Christophi C. The management of liver tumours by percutaneousinterstitial laser thermotherapy. Emirates Medical Journal (Invited review) 2005 23(2) 109-117.
  26. Nikfarjam M, Christophi C. Impact of blood flow occlusion on liver necrosis following focal hyperthermia ANZ Journal of Surgery 2006 Jan-Feb;76(1-2):84-91.
  27. Nikfarjam M, Christophi C. Progressive microvascular injury in normal liver and colorectal liver metastases following focal hyperthermia therapy Lasers in Surgery and Medicine 2005 Jul;37(1):64-73.
  28. Nikfarjam M, Muralidharan V, Christophi C. Altered growth patterns of colorectal liver metastases following focal hyperthermia ablation Surgery 2006 Jan;139(1):73-81.
  29. Nikfarjam M, Christophi C. Altered growth patterns of colorectal liver metastases following focal hyperthermia ablation Surgery 2006 Sep;140(3):479-80.
  30. Harun N, Nikfarjam M, Muralidharan V, Christophi C.Liver regeneration stimulates tumour metastases Journal of Surgical Research 2006 J Surg Res. 2007 Jan 23
  31. Malcontenti-Wilson C, Chan L, Nikfarjam M, Christophi C.Vascular Targeting Agent Oxi4503 inhibits tumoUr growth ofcolorectal liver metastases in a murine model. Journal of Gastroenterology and Hepatology2007 Jun.
  32. Nikfarjam M, Cuthbertson CM, Malcontenti-Wilson C, Muralidharan V, Millar I, ChristophiC.Hyperbaric oxygen therapy reduces severity and improves survival in severe acute pancreatitis. J GastrointestSurg 2007 Aug;11(8):1008-15.
  33. Daruwalla J, Greish K, Nikfarjam M, Millar I, Malcontenti-Wilson C, Iyer AK, ChristophiC.Evaluation of the effect of SMA-pirarubicin micelles on colorectal cancer liver metastases and of hyperbaric oxygen in CBA mice. J Drug Target 2007 Aug;15(7):487-95.
  34. Nikfarjam M, Warshaw AL, Axelrod, L, Deshpande V, Thayer SP, Ferrone CR, Fernandez-del Castillo C. Improved Contemporary Surgical Management of Insulinomas: A 25-year Experience at the Massachusetts General Hospital. Annals of SurgeryJan;247(1):165-72 2008.
  35. Low S, Strugnell N, Nikfarjam M. Ischaemic Colitis Associated with Bowel Carcinoma. ANZ journal of surgery Apr;78(4):319-21 2008.
  36. Nikfarjam M, Staveley-O'Carroll, Gusani, Kimchi. Colorectal metastases to the pancreas. Journal of gastroenterology and hepatology Jul;23(7 Pt 1):1161 2008.
  37. Nikfarjam M, Kimchi E, Shereef S, Gusani NJ, Jiang Y, Liang J, Sehmbey M, Staveley-O'Carroll KF.Surgical Outcomes of Patients with Gastrointestinal Stromal tumours in the Era of Targeted Drug Therapy. J Gastrointest Surg. J Gastrointest Surg. 2008 Jun 11 2008
  38. Avella D, Garcia L, Gusani NJ, Nikfarjam M,Shereef S, Kimchi ET, Staveley-O'Carroll KF. Human Acellular Dermal Matrix: An Innovative Tool for DiaphragmaticReconstruction in Patients with Large Intra-abdominal tumours. J American Surgery2010 Jan;199(1):e12-6. Epub 2009 Oct 17
  39. Jiang Y, Lee M, Montero AJ, Kimchi ET, Nikfarjam M, Staveley-O'Carroll KF. Optimizing ImatinibMesylate in Gastrointestinal Stromal tumours. Gastrointestinal Cancer Research2008 Sep;2(5):245-50
  40. Choudry HA, Nikfarjam M, Liang J, Kimchi ET, Conter, R, Gusani NJ, Staveley-O'CarrollKF.Diagnosis and Management of Retroperitoneal Ancient Schwannomas.World Journal of Surgical OncologyWorld J SurgOncol. 2009 Feb 2;7:12.
  41. Nikfarjam M, Shereef S, Kimchi ET, GusaniNJ, JiangY, Avella D, Mahraj R, Staveley-O'Carroll KF. Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Annals of Surgical Oncology 2009 Jul;16(7):1860-7. Epub 2008 Nov 27.
  42. Nikfarjam M, Kimchi ET, Gusani NJ, Avella Staveley-O'Carroll KF. Reduced Delayed Gastric Emptying with Non-pylorus Preserving Pancreaticoduodenectomy and AntecolicGastrojejunal Anastomosis. Journal of Gastrointestinal Surgery2009 Sep;13(9):1674-82. Epub 2009 Jun 23
  43. Cherenfant J, Nikfarjam M, MathewA, Staveley-O'CarrollKF. Completion pancreatectomy for treatment of a Clostridium perfringenspancreatic infection.Archives of Surgery2009 Apr;144(4):368-70.
  44. Nikfarjam M,SehmbeyM,Kimchi ET, GusaniNJ, ShereefS, AvellaDM, Staveley-O'CarrollKF. Additional organ resection combined with pancreaticoduodenectomy does not increase post-operative morbidity and mortality. Journal of Gastrointestinal Surgery2009 Sep;13(9):1674-82. Epub 2009 Jun 23.
  45. Kimchi ET,Nikfarjam M, Gusani NJ, Avella DM, Staveley-O'Carroll KF, Combined pancreaticoduodenectomy and extended right hemicolectomy - Outcomes and Indications. HPB Surgery 2009 (In Press).
  46. Nikfarjam M, Gusani NJ, Kimchi ET, Mahraj RP, Staveley-O'Carroll KF .Combined Right Nephrectomy and Pancreaticoduodenectomy - Indications and Outcomes. Journal of the Pancreas Jul 10;9(4):449-55 2008
  47. Nikfarjam M, KimchiET, GusaniNJ, AvellaDM, Shereef S, Staveley-O'Carroll KF. Reduction of surgical site infections by use of pulsatile lavage irrigation device after prolonged intra-abdominal operative procedures. The American Journal of Surgery2009 Sep;198(3):381-6. Epub 2009 Apr 2
  48. Nikfarjam M, Kimchi ET, Gusani, Staveley-O'Carroll KF. Complete Surgical Resection of Giant Mucinous Hepatic Cystadenomas. American Surgeon 2010: 76:5: E17-E19(3).
  49. Nikfarjam M, Staveley-O'Carroll KF,Kimchi ET, Hardacre JM.Pancreaticoduodenectomy in patients with a history of Roux-en Y gastric bypass surgery. Journal of the Pancreas2009 Mar 9;10(2):169-73.
  50. Nikfarjam M, Rosen M, Todd Ponsky MD.Early Management of Traumatic Pancreatic Transection by Spleen Preserving Laparoscopic Distal Pancreatectomy. Journal of Paediatric Surgery2009 Feb;44(2):455-8.
  51. Nikfarjam M,Onders RP, Marks JM. Duct of Luschka. Asian Journal of Endoscopic Surgery2010 3(2)97-98.
  52. Nikfarjam M, McGee MF, Trunzo JA, Onders MDRP, Pearl JP, Poulose BK, Chak A, Ponsky JL, Marks JM, Transgastric Natural Orifice Translumenal Endoscopic Surgery (NOTES) Peritoneoscopy in Humans: A Pilot Study in Efficacy and Gastrotomy Site Selection. GIE 2010 Aug;72(2):279-83. Epub 2010 Jun 11
  53. Nikfarjam M, Champagne B, Reynolds HL, Poulose BK, Ponsky JL, Marks JM. Acute management of stoma related colocutaneous fistula by temporary placement of a self expanding plastic stent. Surgical Innovations 2009 Sep;16(3):270-3. Epub 2009 Aug 31
  54. Trunzo JA, McGee MF, Cavazzola LT, Schomisch S, Nikfarjam M, Bailey J, Mishra T, Poulose BK, Lee YJ, Ponsky JL, Marks JM. Peritoneal inflammatory response of natural orifice translumenal endoscopic surgery (NOTES) versus laparoscopy with carbon dioxide and air pneumoperitoneum. Surg Endoscopy. 2010 Jan 28
  55. Nikfarjam M,Faulx A, Laughinghouse M, Marks M. Feasibility of radiofrequency ablation for the treatment of chronic radiation proctitis Surgical Innovations 2010 Jun;17(2):92-4.
  56. Story A, Mariampillai E, Nikfarjam M, Howard M, Onders R. Anaesthetic aspects of implanting diaphragmatic pacing in patients with spinal cord injury. Anaesthesia and Intensive Care2010 Jul;38(4):740-3.
  57. Nikfarjam. Pylorus preserving pancreaticoduodenectomy. Saudi Journal of Gastroenterology 2010 Apr-Jun;16(2):65
  58. Hadj AK, Malcontenti-Wilson C, Nikfarjam M, Christophi C. Lymphatic Patterns of Colorectal Liver Metastases.. J Surg Res. 2010 Oct 8
  59. Kohn GP, Nikfarjam M The effect of surgical volume and the provision of residency and fellowship training on complications of major hepatic resection.JGastrointest Surg. 2010 Dec;14(12):1981-9. Epub 2010 Sep 8
  60. Daruwalla J, Nikfarjam M, Greish K, Malcontenti-Wilson C, Muralidharan V, Christophi C, Maeda H.. In vitro and in vivo evaluation of tumoUr targeting styrene-maleic acid copolymer-pirarubicin micelles: Survival improvement and inhibition of liver metastases. Cancer Sci. 2010 Aug;101(8):1866-74. Epub 2010 May 17
  61. Nikfarjam M, Story A, Nunn A, Howard M. Direct diaphragmatic pacing. ANZ Journal of Surgery 2010 (in Press)
  62. Trunzo JA, Poulose BK, McGee MF, Nikfarjam M, Schomisch SJ, Onders RP, Jin J, Chak A, Ponsky JL, Marks JM. The diagnostic efficacy of natural orifice transluminal endoscopic surgery: is there a role in the intensive care unit? SurgEndosc. 2010 Oct;24(10):2485-91. Epub 2010 Mar 24
  63. Lai J, Crowley C, Nikfarjam M. Concurrent Lymphoma and Pancreatic Adenocarcinoma. Journal of the Pancreas 2011 Mar 9;12(2):185-9.
  64. Hadj AK, Goodwin M, Schwalb H,  Nikfarjam M. Pseudoaneurysm of the Hepatic Artery. Journal of Gastrointestinal Surgery 2011 Oct;15(10):1899-901. Epub 2011 May 2
  65. Fifis T, Malcontenti-Wilson C, Amidjojo J,  Angonno, B, Muralidharan V, Nikfarjam M, Christophi C. Changes in Growth Factor Levels Following Thermal Ablation in a Murine Model of Colorectal Liver Metastases. HPB (Oxford). 2011 Apr;13(4):246-55
  66. Nikfarjam M , Niumsawatt V, Sethu A,  Fink M,  Muralidharan , Starkey G,   Jones R, Christophi C. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB Surgery 2011 Apr;13(4):246-55
  67. Lightfoot N, Santos P, Nikfarjam M, Paraganglioma mimicking a pancreatic neoplasm. Journal of the Pancreas 2011 May 6;12(3):259-61.
  68. Nikfarjam M, Hadj A, Goodwin M. Pseudoaneurysm of the Hepatic Artery – response to Authors Journal of Gastrointestinal Surgery 2011
  69. Rowe D, Nikfarjam M. Cystic duct clip migration into the common bile duct. Indian J Gastroenterol. 2012 Apr;31(2):86.
  70. Nikfarjam M, Frias-Kletecka C, Hardacre J. Gastrointestinal: Duodenal tumour and cutaneous skin lesions. J Gastroenterol Hepatol. 2012 Feb;27(2):414.
  71. Lin WX, Fifis T, Malcontenti-Wilson C, Nikfarjam M, Muralidharan V, Nguyen L, Christophi C. Induction of Th1Immune responses following laser ablation in a murine model of colorectal liver metastases. J Transl Med. 2011 May 29;9:83.
  72. Nikfarjam M, Manya K,  Fink M,  Hadj A, Muralidharan , Starkey G,  Jones R, Christophi C. Outcomes of patients with histologically proven acute acalculous cholecystitis.  ANZ Surgery Dec;82(12):918-22 2012
  73. Nikfarjam M , Harnaen, E, Tufail F, Muralidharan V, Fink MA,  Starkey G,   Jones R, Christophi C. Sex differences and outcomes of management of acute cholecystitis. www.ncbi.nlm.nih.gov Surgical laparoscopy endoscopy and percutaneous techniques 2013 Feb;23(1):61-5
  74. Nikfarjam M, Houli N, Tufail F, Weinberg L, Muralidharan V, Christophi C. Reduction in delayed gastric emptying following non-pylorus preserving pancreaticoduodenectomy by addition of a Braun enteroenterostomy Journal of the Pancreas 2012 Sep 10;13(5):488-96
  75. Lightfoot N & Nikfarjam M, Embryonal Sarcoma of the liver in an adult patient. Case reports in surgery  2012;2012
  76. Nikfarjam M, Weinberg L,  Lowe P,  Fink M,  Muralidharan V,  Houli N, Starkey G, Jones R,  Christophi C. A fast track recovery program significantly reduces hospital length of stay following uncomplicated pancreaticoduodenectomy. Journal of the Pancreas 2013 Jan 10;14(1):63-70
  77. Nikfarjam M,  Hadj AK, Muralidharan V, Tebbutt N,  Fink MA, Jones RM,  Starkey G,  Vaughan RB,  Marshall A, Christophi C Biliary stenting versus surgical bypass for palliation of periampullary malignancy. Indian Journal of gastroenterology Indian J Gastroenterol. 2012 Nov 16.
  78. Pérez-Mancera PA, Rust AG, van der Weyden L, …. Nikfarjam M….. Tuveson DA. The deubiquitinase USP9X suppresses pancreatic ductal adenocarcinoma. Nature. 2012 Apr 29;486(7402):266-70. doi: 10.1038/nature11114.
  79. Biankin AV, Waddell N, Kassahn KS, Gingras MC, … Nikfarjam M … McPherson JD, Gibbs RA, Grimmond SM.  Pancreatic cancer genomes reveal aberrations in axon guidance pathway genes. Nature. 2012 Nov 15;491(7424):399-405. doi: 10.1038/nature11547. Epub 2012 Oct 24.
  80. RON is not a prognostic marker for resectable pancreatic cancer.Tactacan CM, Chang DK, Cowley MJ, Humphrey ES, Wu J, Gill AJ, Chou A, Nones K, Grimmond SM, Sutherland RL, Biankin AV, Daly RJ, Nikfarjam M et al.   BMC Cancer. 2012 Sep 7;12:395. doi
  81. Nguyen L, Fifis T, Malcontenti-Wilson C, Chan LS, Costa PL, Nikfarjam M, Muralidharan V, Christophi C. Spatial morphological and molecular differences within solid tumors may contribute to the failure of vascular disruptive agent treatments. BMC Cancer. 2012 Nov 15;12(1):522.
  82. Chandran S, Nikfarjam M  The Utility of upfront double wire guided biliary cannulation technique following early unintentional pancreatic wire cannulation in patients undergoing endoscopic retrograde cholangiopancreatography. Indian Journal of Gastroenterology  2013 May 3.
  83. Weinberg L, Houli N, Nikfarjam M. Improving outcomes for pancreatic cancer: radical surgery with patient-tailored, surgery-specific advanced haemodynamic monitoring. BMJ Case Rep. 2013 Apr 30;2013
  84. Nikfarjam M, Shen L, Fink M, Muralidharan V, Starkey G,  Jones R, Christophi C Percutaneous cholecystostomy for treatment of acute cholecystitis in the era of early laparoscopic cholecystectomy Surgical laparoscopy endoscopy and percutaneous techniques Surg Laparosc Endosc Percutan Tech. 2013 Oct;23(5):474-80
  85. Nikfarjam M,  Yeo D,   Perini M, Fink M,  Muralidharan V , Starkey G,  Robert M. Jones,  Christophi C. Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surgery ANZ J Surg. 2013 Aug 1. doi: 10.1111/ans.12313
  86. Christophi C., Muralidharan V, Nikfarjam M, Banting, J, Nguyen, L,  Colorectal Liver Metastases - A Case for Sentinel Node Mapping.  HPB (Oxford). 2013 Jul 19. doi: 10.1111/hpb.12118
  87.  Nikfarjam M, Yeo D, He H, Baldwin G,  Fifis T,  Costa P, Tan B, Yang E, Wen S, Christophi C. Comparison of two syngeneic orthotopic murine models of pancreatic adenocarcinoma.  Journal of Investigative Surgery 2013 Aug 19.
  88. Fifis T, Nguyen L, Malcontenti-Wilson C, Chan L, Costa P,  Daruwalla J, Nikfarjam M, Muralidharan V, Waltham M , Thompson EW,  Christophi C Treatment with the vascular disruptive agent OXi4503 induces an immediate and widespread Epithelial to Mesenchymal Transition (EMT) in the surviving tumor. Cancer medicine 2013 Oct;2(5):595-610
  89. Nikfarjam M, Weinberg L, Fink MA, Muralidharan V, Starkey G, Jones R, Staveley-O'Carroll K, Christophi C. Pressurized Pulse Irrigation with Saline Reduces Surgical-site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial. World J Surg. 2014 Feb;38(2):447-55.
  90. Yeo D, Huynh N, Beutler J, Christophi C, Shulkes A, Baldwin G, He H, Nikfarjam M, Glaucarubinone and Gemcitabine Synergistically Reduce Pancreatic Cancer Growth via Down-Regulation of P21-Activated Kinases. Cancer Letter 2014 (in Press)

Books and Book Chapters

Book

  1. Nikfarjam M. The Effect of laser induced thermal ablation on liver tumours. Publisher: VDM Verlag (July 2008)

Book Chapter

  1. Nikfarjam M & Ponsky J Atlas of the Pancreas. Chapter 7. Endoluminal approaches to pancreatic pseudocyst. American College of Surgeons. 2009 (In Press)
  2. Nikfarjam M & Ponsky J. Endoluminal treatments for gastroesophageal reflux disease. Cameron's Textbook of Surgery 2009
  3. Nikfarjam M & Marks J. Future of NOTES. Cameron's Textbook of Surgery 2009
  4. A Hadj & Nikfarjam M Post-procedural Considerations: Standard patient recovery practices & Identification of post-procedural complications. Principles of Flexible Endoscopy 2012 (in Press)
  • ANZ HPBA
  • Australasian Pancreatic Club
  • Pancare Foundation
  • SSAT
  • APA
  • ASGE
  • AHPBA
  • GESA
  • IHPBA
  • AAS
  • RACS
  • SAGES