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Thirteen year old girl from Palermo operated on her back at Rizzoli in Bagheria

Primary bone cancer removed. The surgery was performed in collaboration with the Palermo Civic Hospital

March 7th, 2024

The Rizzoli-Sicilia Department of Bagheria made an operation to remove a primitive tumor, a sarcoma of Ewing, in a patient of pediatric age.

"Anna will turn 14 tomorrow, March 8, today was the first post-operative check-up and to give her and her family the news of the how the surgery went well. This for us is the greatest professional and human gratification" says Toscano.

Anna (name of fantasy) was visited for the first time at the age of 11 years by Dr. Angelo Toscano, medical director of the General Orthopaedics of Rizzoli-Sicily of Bagheria directed by doctor Giovanni Pignatti: "She had pain in the sciatic nerve, but a particular type of pain that immediately made me suspicious - Toscano recalls. - After in-depth examinations at the Radiology of Villa Santa Teresa we have in fact diagnosed a rare and aggressive primary bone tumor that at Rizzoli we know well, Ewing’s sarcoma, in a lumbar vertebra. From there began the path of treatment".

Anna immediately underwent chemotherapy cycles at the ARNAS Ospedale Civico in Palermo with Dr. Paolo D'Angelo, director of pediatric oncohematology. She responded well to that treatment. Post-treatment chemotherapy tests showed a marked improvement; after some time, however, a recurrence emerged during a checkup.

After the appropriate pre-surgery treatments, on Friday 9 February the team of the Rizzoli-Sicily Department composed for the circumstance by the Director of Spinal Surgery of Rizzoli of Bologna Dr. Alessandro Gasbarrini, by Dr. Angelo Toscano and Dr. Fabrizio Perna of the General Orthopaedics of the Bagheria office, by the Director of Anesthesia and Intensive Care Dr. Jacopo Frugiuele and by all the staff of the operating room performed the removal of the tumor.

Dr. Angelo Toscano e Dr. Jacopo Frugiuele
Dr. Angelo Toscano together with Dr. Jacopo Frugiuele 

"First of all we stabilized with screws and then bars the spine and isolated and protected marrow and roots, then we proceeded to the removal of the discs between the vertebral bodies, above and below the vertebra affected by the sarcoma. Subsequently, through a second surgical access, in this case lateral, we also removed a part of muscle psoas to have a wider clean margin - explains Doctor Toscano. - The vascular surgical team of Professor Francesco Talarico of the Palermo Civic Hospital was present in the operating room, and was in charge of isolating the arterial and venous vessels in front of the diseased vertebra. Before the surgery, Anna also underwent an embolization of the lumbar arteries, this time directly at the Civico, a hospital with which the Rizzoli-Sicily Department has long-established collaboration, at the Interventional Radiology directed by Dr. Mario Vallone. It was a fundamental step to control and prevent bleeding in the operating room".

The discs between the vertebrae, removed along with the diseased vertebra, were replaced by Rizzoli’s surgeons with a modular carbon prosthesis so that a course of radiotherapy could be performed. "The modular prosthesis is like a series of bricks, it is assembled until you get the appropriate measure to restore in this case the correct lordosis, that is by reproducing the ideal curve that resembles as much as possible the native curve of the spine" adds Toscano.

"It is the first time that we perform at Rizzoli-Sicilia the removal of a primary bone tumor in a patient in pediatric age - emphasizes Dr. Gasbarrini. - The surgery was carried out perfectly, at Rizzoli the vertebrectomies that we perform for aggressive tumors such as Ewing’s sarcoma, chordoms, chondrosarcomas, osteosarcomas, giant cell tumors, osteoblastomas are all customized. In relation to the extension of the tumor, in fact, we must understand how much of bone and possibly tissue resear, also planning the prosthesis with which we will then replace what removed. In this case the carbon prosthesis was the most appropriate choice to allow Anna to complete her course of care".

"Rizzoli has always been a point of reference for children and young people with complex orthopaedic and oncological problems. The first intervention on bone cancer in the Institute was made exactly one hundred years ago, in 1924, when this extremely aggressive disease was almost unknown - explains the General Director of the Orthopedic Institute Rizzoli, Anselmo Campagna. - There are over 50 thousand patients that we have followed in the field of oncology and have the opportunity to do so in Bagheria is a great result for us. Being able to treat people with the most advanced clinical and surgical methods developed thanks to research, is among our main missions as IRCCS, our profile of reference scientific hospital for orthopedics. For Sicilian patients, thanks to the agreement between the Emilia-Romagna and Sicilian Region, the possibility of doing so near the place of residence is added, and this also means a lot for the life of families especially when it comes to diseases that require long periods of treatment or numerous controls".

"The effective and profitable collaboration of ARNAS Civico with the Rizzoli-Sicily Department has been active for over twelve years - underlines the Extraordinary Commissioner Walter Messina. - Having been able to collaborate and participate in this important surgery intervention is the confirmation of how much the exchange of competences leads to great results. We will continue to work together whenever the clinical cases to be treated require multidisciplinary skills for the benefit of all patients who decide to turn to our facilities".

"Once again the competence of our health professionals, together with our Sicilian colleagues, allowed us to work in a very complex case, returning the smile to Anna, to whom we send a big hug for her birthday, with a wish for a life in which he can realize all his dreams - says the Councillor for Health Policies of the Emilia-Romagna Region Raffaele Donini. - Public health is this, a health can collaborate between territories, putting the highest skills in the country and taking on the most complex situations. I would like to thank the health workers who contributed to the speech, also on behalf of the regional government of Emilia-Romagna".

"I wish happy birthday and a bright future full of satisfaction and happiness to little Anna - says the Health Councillor of the Sicilian Region Giovanna Volo. - I want to express great satisfaction for how the collaborative synergy established for years with the Emilia-Romagna RegionRomagna, the Rizzoli Institute and the ARNAS Civic of Palermo have been able to guarantee in our island such an important operation in grat safety and exceptional results. We hope that more and more interventions of great complexity and high standards can be guaranteed to Sicilian citizens, also thanks to the collaboration between Regions and the daily dedication of the professionals involved. The objective of our region is to ensure Sicilian citizens the right to health and assistance, in complete safety and on their territory".


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