A kidney tumour in an 18-month-old girl and an abdominal sarcoma in a two-and-a-half-year-old girl were removed just days apart by the team led by Ernesto Leva, in collaboration with specialists from Milan’s National Cancer Institute.
The Paediatric Surgery team at the Policlinico di Milano performed two exceptional procedures on two young patients affected by very rare and aggressive tumours who were admitted to the hospital during the same week.
The first involved an 18-month-old girl with a rare kidney tumour that had already begun to affect the liver and diaphragm. It was an extremely delicate situation requiring a multidisciplinary approach involving a range of specialist expertise.
The approximately 12-centimetre mass, weighing almost one kilogram, was removed by Alfredo Berrettini, Director of Paediatric Urology at the Policlinico di Milano. Anaesthesiologists, paediatric intensive-care specialists and experts in diaphragmatic reconstruction also made an essential contribution, allowing the team to preserve the liver’s function and anatomy.
The team from the hospital’s General Surgery and Liver Transplant Unit, led by Cristiano Quintini, also played an important role. The case was assessed in depth by teams at the Policlinico di Milano in collaboration with colleagues at the Istituto Nazionale dei Tumori di Milano (National Cancer Institute of Milan). Its urological surgeon, Davide Biasoni, took part in the operation, which was performed in the hospital’s historic Alfieri Pavilion. Surgery was identified as the most effective therapeutic option for increasing the patient’s chances of recovery.
Just a few days later, another two-and-a-half-year-old girl underwent emergency surgery to remove a sarcoma located in the front of the abdomen. As one of the most dangerous forms of cancer affecting children, the tumour required immediate action.
A highly complex procedure was performed to remove the approximately six-centimetre mass and reconstruct the abdominal wall. The operation was carried out by Ernesto Leva, Director of Paediatric Surgery at the Policlinico di Milano, with the crucial collaboration of Marco Fiore, an expert in the treatment of sarcomas at the National Cancer Institute of Milan.
The stories of the two young patients intersected in the corridors of the Paediatric Surgery ward at the Policlinico di Milano. Both families live in the Lombardy region, but patients could come from anywhere in Italy because the Policlinico’s Maternal and Child Health Department, led by Ernesto Leva, who is also Director of the School of Paediatric Surgery at the University of Milan, is a nationally recognised centre for solid tumours in children.
For some time, the Policlinico has maintained an active collaboration and shared clinical cases with the Paediatric Oncology Unit of the National Cancer Institute of Milan, ensuring a highly specialised multidisciplinary approach.
Faced with situations this complex in children this young, the winning strategy is to share the knowledge and expertise of surgical professionals in order to provide the best possible care, while keeping the wellbeing of these very young patients at the centre of everything we do.
Ernesto Leva, Director of the Policlinico di Milano’s Maternal and Child Health Department
“The Policlinico di Milano’s role as a referral centre for the diagnosis and treatment of many congenital conditions has been strengthened over time, providing therapies and surgical procedures that are available in only a small number of highly specialised centres. This is another reason why it is important to build networks between specialised institutions. For paediatric solid tumours, we have had an agreement with the National Cancer Institute of Milan for years, allowing our surgical and anaesthesia teams to collaborate and, together with the specialists from its Paediatric Oncology Unit, led by Maura Massimino, to jointly assess cases referred to either institution. Around 40 cases are followed each year, which is a significant number in paediatric oncology. It is an example of a hospital network in which all of us have the privilege of putting the knowledge and experience gained, including abroad, at the service of our youngest patients.”
“The collaboration with the Policlinico di Milano is a source of great satisfaction for our Institute and fully reflects our mission and institutional objectives,” said Gustavo Galmozzi, President of the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano.
“The ability of two IRCCS institutions to pool and integrate expertise, professional skills and resources allows each to build on its specific strengths and create increasingly effective care pathways capable of responding even to the most complex needs. It is a model of collaboration that contributes to the growth of both institutions and finds its deepest meaning in always placing the patient, their needs and their healthcare requirements at the centre.”
“It is important to recognise the crucial role played by operating-room nurses, who are essential to the careful management of these complex procedures, as well as the healthcare professionals in the Paediatric Surgery ward,” added Ernesto Leva. “The staff often includes mothers and fathers who must be able to manage the emotional impact of even the most difficult or delicate situations treated here. Working with expertise while never overlooking the human and compassionate side of care is another quality that reflects the true nature of our professionals’ expertise.”
“At the Policlinico di Milano, specialists from many different disciplines work together, combining their experience with access to new equipment and technologies. This increases our ability to meet the challenges posed by medicine together,” said Matteo Stocco, General Director of the Policlinico di Milano.
“Families who come to us also know that they can be supported by our professionals for many years, because our hospital provides specialised care at every stage of life, allowing the long-term monitoring of young patients to transition seamlessly into adult care.”
“Experiences like this demonstrate how important it is to support clinical collaboration between our institutions with organisational models capable of making that collaboration increasingly stable, structured and effective, particularly in cases such as these involving paediatric cancers with low epidemiological frequency and requiring a high level of specialised expertise,” said Maria Teresa Montella, General Director of the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano.
“Our objective is to further strengthen these synergies and create the conditions for highly specialised expertise to be integrated continuously, transforming successful experiences into shared care pathways and new opportunities for development. This is a collaboration that we want to strengthen over time, contributing, through improvements to our organisations, to the overall quality of healthcare in Lombardy.”
“Stories like these capture the deepest meaning of what it means to be the Policlinico: putting expertise, research and the ability to build networks at the service of patients, especially when they are so young and vulnerable. It is also a testament to the strength of the Lombardy regional healthcare system, which is capable of bringing together its centres of excellence to respond to the most complex situations. The entire hospital extends its thanks to the teams who make all of this possible every day,” concluded Marco Giachetti, President of the Policlinico di Milano.
