Mehrdad Nikfarjam MD

Certification

• Medical Board of Victoria, Australia
  (Active License)
• Royal Australasian College of Surgeons
  Australia
• General Medical Council – UK
• ECFMG Registration – USA
• USMLE step 1,2,3 - USA
• Pennsylvania Medical Board – USA
  (Active Full License)
• Ohio Medical Board – USA
  (Active Full License)

Society Memberships

• IHPBA - International Hepato pancreaticobiliary Association
• AHPBA – American Hepato Pancreatico-Biliary Association
• RACS - Royal Australasian College of Surgeons
• GESA - Gastroenterological Society of Australia
• ANZ HPBA – Australia and New Zealand Hepato pancreaticobiliary Association
• SSAT - Society for surgery of the Alimentary tract
• SAGES – Society of American Gastrointestinal and Endosocpic Surgeons
• ASGE - American Society for Gastrointestinal Endoscopy
• AAS - Association of Academic Surgery
• APA – American pancreatic association
• Pancreas Club

Journal Reviewer:

• Annals of Surgical Oncology
• ANZ Journal of Surgery
• European Journal of Surgical Oncology
• Journal of Gastrointestinal Surgery
• Journal of the Pancreas
• Annals of Surgery
• Surgical Endoscopy
• GIE
• American Journal of Surgery
• Saudi Journal of Gastroenterology

Academic Record

• Medical Bachelor and Bachelor of Surgery (MB.BS.) (Hons) 1997 Monash University, Australia
• Doctorate of Philosophy (PhD) 2005 University of Melbourne, Australia "The Effect of Laser Induced Thermal Ablation on Liver Tumours"
• F.R.A.C.S. Royal Australasian College of Surgeons (May 2006)
• Medical Doctorate (MD) 2007 – Pennsylvania, USA

Awards

Undergraduate

• First Class Honours Monash University 1997
  High Distinction in all final year subjects, including Surgery, Medicine, Paediatrics, Obstetrics and Gynaecology
• Prince Henry’s Prize in Surgery 1997
• Sigma Award in Neonatal Paediatrics 1997

Postgraduate

• D S Rosengarten Research Award 2002 - Monash University
  “Focal hyperthermia produces progressive necrosis independent of its initial thermal effects”
• Austin hospital, Surgery and Anaesthetic research Prize 2003 – University of Melbourne
  “Effects of inflow vascular occlusion on the effects of focal hyperthermic tissue necrosis”
• RC Bennett Research Medal Prize 2004 – Royal Australasian College of Surgeons
  “SMA Pirarubicin combined with hyperbaric oxygen therapy for the treatment of colorectal liver metastases”
• Austhos Travelling Research Fellowship 2004 – Austin Hospital, Ludwig institute and University of Melbourne
  “Mechanisms of focal hyperthermia tumour destruction”
• Sir Edward Hughes Memorial Research Award 2004 – Monash University
  “Hyperbaric oxygen therapy for the treatment of severe acute pancreatitis”
• Royal Australian College of Surgeons – Travelling Fellowship 2006
  Liver pancreatic and foregut surgery
• Travelling fellowship – American Pancreatic Association – Chicago 2007
  Improved Contemporary Surgical Management of Insulinomas: A 25-year Experience at the Massachusetts General Hospital
• Royal Australian College of Surgeons – Travelling Fellowship 2008
  Minimally invasive laparoscopic and endoscopic surgery

Post Graduate Experience

Clinical Experience

My training has been within the field of general surgery, with specialization in Advanced liver, pancreas and biliary surgery. I received my board certification in surgery in Australia (F.R.A.C.S) at start of 2007 after which I continued with further training the USA for 2½ years in Liver, Pancreas and Foregut Surgery and Minimally Invasive Laparoscopic and Endoscopic surgery. I have a particular interest in liver and pancreatic cancer. In particular the treatment of locally advanced or borderline resectable cancer. I also have a strong interest in re-operative liver and pancreatic surgery and advanced laparoscopic pancreas and liver surgery. I am one of the few surgeons in Australia who performs laparoscopic pancreaticoduodenectomy (Laparoscopic Whipple’s Procedure). My basic research interests are in the areas of pancreatic cancer, pancreatitis and colorectal liver metastases. I am currently a Lecturer on the HPB / Transplant unit at the Department of Surgery, University of Melbourne, Austin Hospital. My private practice is in Warringal, Mitcham and Epworth hospitals.

My specific interest is in the field of Hepatobiliary and Pancreatic surgery, which includes:

2009 - present University of Melbourne, Austin Hospital, Melbourne, Australia. I am currently a lecturer and consultant on the hepatobiliary pancreatic and transplant unit at the Austin Hospital, with a major focus on minimally invasive surgery. Currently I perform in excess of 50 major pancreatic and liver resections annually, with a focus on advanced and minimally invasive surgery.

2008 – 2009 University Hospitals, Case Medical Center, OH, USA
I was an Instructor and Fellow at University Hospitals, completing an advanced laparoscopic and endoscopic fellowship with a major interest in ERCP and laparoscopy, including laparoscopic pancreatectomy and single site surgery, under the supervision of Dr J. Ponsky, MD and J. Marks MD. Training in endoscopic ultrasound (EUS) through the gastrointestinal unit was also obtained. This position was secured competitively through the Fellowship Council.

2007 – 2008 Penn State Milton S. Hershey Medical Center, PA, USA. I completed a 1 year clinical Fellowship on the liver, pancreas and foregut unit under the supervision of Dr K Staveley-O’Carroll MD, PhD. I was an instructor in the department of surgery during this period. My clinical experience during this period included 50-75 major pancreatic resections, 50-75 major liver resections, 25-50 complex biliary cases, 25-50 esophagogastric cases and 10-25 complex retroperitoneal tumor resections. I am experienced in laparoscopic pancreatic and liver surgery. This was a competitively matched position through the Fellowship council.

2007 – Massachusetts General Hospital, MA, USA. Three months was spent as on the pancreatic unit with Dr A.L. Warshaw MD, and Dr C. Fernandez-del Castillo MD in 2007 prior to commencement of my Fellowship at Penn State.

2006 – 2007 Austin Hospital, Melbourne, Australia. I was the Senior Advanced Trainee (Chief resident) on the Hepatobiliary and Pancreatic unit, and Fellow (Instructor) of the University of Melbourne, at the Austin Hospital in 2006 under the supervision of Professor C. Christophi for 6 months after completing my examination requirements for my F.R.A.C.S.

2005 – 2006 Austin Hospital, Melbourne Australia. I was the Senior Advanced Trainee (Chief resident) Upper Gastrointestinal surgery training under the supervision of Dr M. Douglas and Dr T. Sweeney, with a special interest in laparoscopic upper gastrointestinal surgery.

2003 – 2004 Austin Hospital. I worked on the Hepatobiliary and Pancreatic unit and the Liver Transplantation unit, under the supervision of Professor C Christophi and Professor R Jones, while completing my Doctorate of Philosophy (PhD). I was involved in organ harvests, liver transplantation and major complex liver and pancreatic resections. I also had major teaching commitment to medical students and Royal Australian College of surgeons during this time.

2002 – 2003 Alfred Hospital, Australia. My initial experience in hepatobiliary, Pancreatic and Upper Gastrointestinal surgery was after commencement of my PhD under the supervision of Professor P O’Brien and Professor C. Christophi. I was also involved in major liver and pancreatic surgery during this time. I also had major teaching commitment to medical students and Royal Australian College of surgeons during this time.

Teaching and Education

Academic Details

• Medical Bachelor and Bachelor of Surgery (MB.BS.) (Hons) 1997 Monash University, Australia
• Doctorate of Philosophy (PhD) 2005 University of Melbourne, Australia "The Effect of Laser Induced Thermal Ablation on Liver Tumours"
• F.R.A.C.S. Royal Australasian College of Surgeons (May 2006)
• Medical Doctorate (MD) 2007 – Pennsylvania, USA
  

Undergraduate

• 2002 – Monash University - 3rd, 4th, 5th and 6th year medical school clinical program tutor
• 2003 – 2006 - University of Melbourne – 4th and 5th year medical school clinical teaching
• 2006 – 2009 Honorary Fellow/Lecturer in Department of Surgery, University of Melbourne
• 2007 – 2008 Instructor, Penn State University, Hershey Medical Center PA, USA
• 2008 – 2009 Instructor, University Hospitals, Case Medical Center, Ohio, USA
• 2009 – Examiner, University of Melbourne

Postgraduate

• 2002 – 2004 Royal Australasian College of Surgeons - Convener Advanced Trainee Seminar Programme, Melbourne, Victoria 2002-2004
• 2007 – 2008 Resident teaching seminars – Penn State University, Hershey Medical Center, PA, USA
• 2008 – Faculty, SAGES Laparoscopic and Endoscopic workshop, Cincinnati, OH, USA
• 2008 – Instructor, Advanced Gastroenterology Fellows Endoscopic workshop, Cleveland, OH, USA
• 2008 – 2009 Resident teaching seminars – University Hospitals, Case Medical Center, Ohio, USA
• 2008 – 2009 Fundamentals of Laparoscopic Surgery training, University of Hospitals, Case Medical Center, Ohio USA

Students Supervised

Honours

• 2004 Jurstine Darawalla BS – University of Melbourne, Effect of anti-angiogenic factors of the treatment of colorectal liver metastases
• 2005 Nadia Harun BS – University of Melbourne, Effect of liver regeneration on growth of colorectal liver metastases
• 2005 Lisa Chan BS - University of Melbourne, Effect of anti-vascular agent of Oxi4503 on colorectal liver metastases

Masters in Surgery

• 2005 Michael Fanartzis, MBBS (Hons) – University of Melbourne.  Effect of liver regeneration on colorectal liver metastases
• Surgical Research (USA)
  2007, Diego Avella, MD, Penn State School of Medicine, The role of immunologic ignorance and tolerance on hepatic tumorigenesis
• 2007, Louis Garcia, MD. Penn State School of Medicine, The role of immunologic ignorance and tolerance on hepatic tumorigenesis
• 2007, Serene Shereef, MD. Penn State School of Medicine,
  Impact of radiofrequency ablation in a murine model of spontaneous hepatocellular cancer

Research

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

Clinical Research

Acute Pancreatitis

The impact of hyperbaric oxygen therapy on patients with severe necrotizing pancreatitis is being assessed. A pilot 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-ampullary tumours. 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).

Pancreatic resection techniques

Interested in methods of reducing the incidence of pancreatic fistula and techniques that reduce rates of delayed gastric emptying (Publication 42).

Outcomes of pancreaticoduodenectomy

Major interest in surgical outcomes of pancreaticoduodenectomy, in particular more advanced resections including additional organs (Publication 44,45, 46)

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.

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).

Basic Research

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 are in the process of publication

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.

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

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 tumor 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 tumorigenesis" Digestive Diseases Week, USA 2008, Avella D, Nikfarjam M …. Staveley-O’Carroll
11. " Surgical outcomes of patients with gastrointestinal stromal tumors 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

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

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 tumors 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 tumor: 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 Tumor 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 tumors. 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 tumor 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 Tumors 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 Tumors. 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 Tumors. 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 tumor 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

Books and Book Chapters

Book

1. Nikfarjam M. The Effect of laser induced thermal ablation on liver tumors. 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

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