Naples. It is not often that you come across an intervention never done before in the world.
An operation that needed to be planned, moving in a field that has no precedents in literature or guidelines to follow. This is what happened at the Cardarelli in Naples, where three different teams saved the life of “grandfather Gennaro”, an 80-year-old patient suffering from pancreatic and laryngeal cancer. The operation, which lasted nine hours, was performed on August 30 and was a complete success.
Grandpa Gennaro's odyssey began in the middle of summer, with symptoms that immediately raised alarm among doctors: dysphonia with respiratory failure and abdominal pain. After carrying out the necessary tests, a dramatic reality emerged: an advanced laryngeal carcinoma and a tumor lesion involving the body and tail of the pancreas. He was immediately admitted to the Surgery Division directed by Professor Charles Mill.
"The patient was referred to us at Cardarelli - explains Professor Molino - due to the complexity of the clinical picture and the presence of pancreatic neoplasia. After all, the department I direct is a center of excellence and reference for this pathology. I spoke with Professor Napolitano and Dr. Ricciardiello and, even though it was the middle of summer, - he adds - I immediately found everyone's collaboration.
This is also what makes Cardarelli what it is: a hospital company where there are strong synergies between specialist excellences that support an emergency room with European record numbers".
The work of the team of anesthetists was also crucial, allowing the two operations to be performed simultaneously, reducing the time and morbidity of the surgical procedure. Given the complexity of the case, a multidisciplinary team was formed for Grandpa Gennaro with radiologists, surgeons, ENT specialists, oncologists, radiotherapists and anesthetists. A close discussion served to define the best possible therapeutic approach.
One of the most complex problems to solve was in fact that of removing the pancreatic tumor to prevent the disease from advancing with a possible metastasis, but at the same time intervening with a laryngectomy, taking into account the respiratory failure. The solution? A simultaneous operation of total laryngectomy with bilateral neck emptying and laposcopy splenopancreatectomy, an operation never attempted before in the world for which three different teams of doctors and six nurses were needed.
In particular, the surgical team directed by Professor Carlo Molino, assisted by Doctors Benedetto Neola and Dalila Lobue, intervened; the ENT team directed by Professor Domenico Napolitano and Doctor Filippo Ricciardiello, assisted by Doctors Giulio Sequino, Pasquale Salomone, Nunzio Accardo and Flavia Oliva and the anesthesiology team directed by Doctor Nino Franciosa, assisted by Doctors Maria Rosaria Cuomo and Raffaele Di Nola. «The study of multiple tumors – explains Doctor Ricciardiello – represents one of the most important challenges in international oncology.
People living after a first diagnosis of cancer are increasingly numerous and represent over 4% of the Italian population. The risk of developing a second tumor is estimated between 10 and 20% of cases in the first 5 years after treatment and this risk increases progressively over time".
Professor Domenico Napolitano is also convinced of the importance of teamwork, for whom «the treatment of multiple tumors is based on a correct multidisciplinary approach. Only a perfect synergy between different specialists allows the objective to be achieved. Just as it happened here at the Cardarelli in Naples».
Thanks to this extraordinary intervention, today grandfather Gennaro returned home to his seven grandchildren: "I was very scared and I felt discouraged. Then I met Professor Molino and Dr. Ricciardiello - he says - who listened to me, reassured me and gave me hope. I talked to my family and decided to try. I trusted in faith and the doctors who work at the Cardarelli in Naples. It was a risk, but one I was convinced of. I did it for them, my family. I want to thank everyone, surgeons, anesthetists, resuscitators, the operating room staff and also those in the department. My prayers were heard, I will pray for all of you".
Satisfaction for this extraordinary intervention was also expressed by the Strategic Management of the Cardarelli of Naples through the voice of the General Manager Giuseppe Longo: "This intervention - he said - is the result of collaboration between different structures of excellence of our Hospital Trust. Multidisciplinarity, competence and integration between the different Operating Units are the basis of a functional and efficient hospital. Despite Covid, the Cardarelli has always remained a center of excellence for emergency-urgency but also for high medical and surgical specialty".
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