Healthcare excellence in the province, high-level cancer surgery at the Castelli hospital

Advanced and widespread ovarian cancer. A complex surgical operation lasting over 12 hours and of great technological level, with the use of intraoperative chemohyperthermia (Hipec-CO2), which only some large hospitals in Italy are able to do. In Lazio so far only Gemelli

An advanced and widespread ovarian cancer. A complex surgical operation lasting over 12 hours and of great technological level, with the use of intraoperative chemohyperthermia (Hipec-CO2), which only some large hospitals in Italy are able to perform and in Lazio only the Gemelli Polyclinic. A challenge that is accepted and won byCastles Hospital in the ASL Rome 6. Today the patient, 66 years old, returned home. A story that demonstrates how high quality care can be obtained even in the local area, far from the metropolises.

“We studied the case, subjected the patient to an exploratory laparoscopy with biopsies that allowed us to characterize the neoplasm and then, after the multidisciplinary discussion, we subjected the patient to cycles of neoadjuvant chemotherapy. The excellent response to oncological therapy, such as documented by diagnostic images, allowed us to continue with a surgical debulking (cytoreduction) operation and contextual intraoperative chemohyperthermia (Hipec-CO2)”. Telling Adnkronos Salute about the challenge are Angelo Serao, director of the General Surgery Unit, and his assistant, general surgeon James Casella, who voluntarily transferred from a Roman facility to the Castelli Hospital to follow Serao.

Together with them they have over 20 professionals, oncologists, radiologists, anesthetists, urologists, gastroenterologists, pathologists, operating room nurses who stayed beyond their working hours and from the various departments (pharmacists, clinical engineers) who, with the general management , have made it possible to complete this great project all within the ASL Roma 6.

“For our garrisons we must not talk about the periphery, but about the response of the territory and a different centrality. The important intervention completed at the Castelli hospital highlights that there is no need for journeys of hope towards Rome or other realities. Here we are able to protect the health of the population well and our esteem and gratitude go to the professionals“. Thus the extraordinary commissioner of ASL Roma 6 Francesco Marchitelli. When asked whether this intervention is a ‘seed’ or a ‘fruit’ of the work, the commissioner is very clear: “It is one of the fruits that comes from high-level daily assistance given to the population, this means that there ‘it is a healthy ‘plant’ that bears healthy fruit – he recalls – It is therefore not a starting point but the demonstration that there is a very high commitment”. There is talk of a shortage of doctors in public healthyoung professionals must understand their horizon is not necessarily in the shadow of the Colosseum where there are very valid hospital realities, but there are structures where it is nice to be able to build something important“, concludes Marchitelli.

“Ovarian cancer has a high mortality rate and in most cases the diagnosis is late, becoming clinically evident when the disease is in an advanced stage, no longer susceptible to surgical treatment. In these cases only chemotherapy allows reduction in the extent of the disease. A good response to adjuvant chemotherapy is a fundamental element for subjecting the patient to demolitive surgery. Traditional chemotherapy and intraoperative chemotherapy directly in the abdomen together with demolitive surgery have given excellent results in terms of survival – explains Serao – In this case the organs hosting the primary neoplasm and all the localized lesions that the disease had caused in the abdominal cavity were removed”.

“Hipec-CO2 through an instillation and aspiration system allows the administration of chemotherapy throughout the abdominal cavity using high temperatures which favor the entry of the drug into the tumor cells, while the carbon dioxide particles favor a homogeneous distribution of the chemotherapy in the abdominal cavity “, underlines Casella. The Castelli hospital “has demonstrated that it is oriented towards the future and with the hope of carrying out other interventions of this type. Even a hospital like ours which is well structured but considered ‘small’ compared to other centers can provide excellent responses to the needs of citizens even on complex interventions”, suggests Serao.

“Only the time required to assemble the Hipec machine is very long – explains Casella – The objective is to remove all the diseased cells and then use the machine to carry out chemotherapy at 42 degrees which conveys the drug to the tumor cells together with the temperature. Often it is used in late-stage tumors, when there is no other possibility.”

“Entrusted to the care of the intensive care medical-nursing staff of the Castelli Hospital for 24 hours, the patient returned to the General Surgery department. The post-operative course – continues Casella – was regular and characterized by a progressive recovery of general and local clinical conditions of the patient who was then discharged”.

The operation completed at the Castelli hospital demonstrates that high-level surgery can also be performed in the province and avoid ‘journeys of hope’ towards the capital or even outside the region. “But also to reduce waiting lists”, specifies Serao. “The difference between our hospital and a large center – he continues – is also the human relationship that is established with the patients. There is more attention and this is a very important value for those hospitalized”.

A Pdta already exists at the Castelli hospital (Diagnostic therapeutic care path) for colorectal cancer. “The Lazio Region has recognized us as a reference center for the treatment of this tumor, our quality is comparable to that of other structures”, recalls Serao. The objective should be to decentralize care in a Region which has a concentration of large hospitals in Rome but also has part of the least served territory. Today the Castelli hospital has sown the seed with a ‘super’ intervention to demonstrate that even ‘small’ hospitals can compete with the ‘big’ ones.