Thoracic Surgery Unit

The Thoracic Surgery Unit of the National Cancer Institute deals with the treatment of tumors of the lung, mediastinum, thoracic wall, and esophagus. It belongs to one of the longest-standing surgical schools in Italy. It was founded in the 1980s by Professor Ravasi and was the first nationally to deal exclusively with oncological Thoracic Surgery. Since 2024, it has been directed by Dr. Piergiorgio Solli. It combines a high technical and assistance level, a strong vocation for research, and an intense training program, with the aim of providing effective and safe care pathways carried out by highly specialized personnel, attentive to the needs and history of the Patient. Surgery is performed by minimizing the invasiveness of the surgical procedure. In adherence to this principle, surgical incisions have always respected all thoracic musculature. Today, thanks to the extensive experience gained in video-assisted (VATS) and robot-assisted (RATS) techniques, the invasiveness of the surgical procedure has been further reduced, and pulmonary and mediastinal resections are performed without opening the chest, where possible. Our structure is a national reference centre for the treatment of

both high-complexity thoracic tumors and rare thoracic tumors that require multidisciplinary expertise. Specifically, it has large experience in mediastinal surgery (with vascular reconstruction), thoracic wall surgery, metastases surgery (with lung tissue sparing), sarcoma surgery, esophageal surgery, and pediatric surgery. The close cooperation with anesthetists and resuscitators has allowed for excellent results over the years in terms of patient safety, even in such complex surgery. Surgery can sometimes be preceded by a complex diagnostic phase or require pre-operative treatment. It is therefore important that the Patient is evaluated, at diagnosis, by all specialists who will participate in their care pathway. For this reason, the Multidisciplinary Thoracic Oncology Group has been active since 2011, bringing together thoracic surgeons, oncologists, and radiation oncologist highly specialized in thoracic pathology, radiologists (specialized in thoracic pathology, lung cancer screening, and interventional methods), endoscopists, pulmonologists, anatomopathologists, and nuclear medicine physicians on a weekly basis to define the best diagnostic and treatment strategy for each case, in light of international protocol indications. Patients who are candidates for surgical intervention are promptly included in a dedicated pre-hospitalization pathway for both preoperative clinical and radiological examinations and a prehabilitation pathway within the ERAS (Enhanced Recovery After Surgery) protocol, aimed at ensuring optimal recovery and an early and safe return to daily activities after operation. Specifically, this protocol may include a comprehensive functional evaluation including preoperative physiotherapy, assessment and correction of nutritional needs, correction of tumor-related chronic anemias, and pain control.

During hospitalization, within the ERAS protocol, the patient is assisted by a specialized nursing team according to an organizational model of personalized assistance (identification of the primary nurse). Furthermore, in the context of research, dedicated Research Nurse support is provided for all patients participating in clinical trials. Clinical Research Over the years, the research vocation of the Thoracic Surgery Unit has translated into participation in multiple research projects, with several publications in international journals with impact factors (link publications*). Specifically, our Structure deals with: · clinical research, by virtue of the large case series accumulated over decades and cooperation with other disciplines and with other Italian and International centers for the creation of multicentric projects and databases; · translational research (thanks to intense collaboration with the experimental oncology group that also focuses on lung cancer) with multiple innovative research lines in the early diagnosis of lung cancer that combine the use of biomarkers in the blood with the use of spiral CT. Excellence also means continuous training, without which any result cannot be maintained over time. For this purpose, Thoracic Surgery annually offers a structured ECM accredited training program dedicated to Doctors and focused on multidisciplinary management and evaluation. Collaborations The Complex Structure Thoracic Surgery also provides its expertise within existing collaborations with: - IRCCS Policlinico San Donato - Cardiac Surgery for the surgical treatment of complex mediastinal neoplasms requiring cardiovascular reconstruction or extracorporeal circulation; - IRCCS Ospedale San Gerardo dei Tintori di Monza (Complex Structure Plastic Surgery) for functional brachial plexus surgery; - IRCCS Istituto Neurologico "Carlo Besta" for the treatment of The Thoracic Surgery Unit of the National Cancer Institute deals with the treatment of tumors of the lung, mediastinum, thoracic wall, and esophagus. It belongs to one of the longest-standing surgical schools in Italy. It was founded in the 1980s by Professor Ravasi and was the first nationally to deal exclusively with oncological Thoracic Surgery. Since 2024, it has been directed by Dr. Piergiorgio Solli. It combines a high technical and assistance level, a strong vocation for research, and an intense training program, with the aim of providing effective and safe care pathways carried out by highly specialized personnel, attentive to the needs and history of the Patient. Surgery is performed by minimizing the invasiveness of the surgical procedure. In adherence to this principle, surgical incisions have always respected all thoracic musculature. Today, thanks to the extensive experience gained in video-assisted (VATS) and robot-assisted (RATS) techniques, the invasiveness of the surgical procedure has been further reduced, and pulmonary and mediastinal resections are performed without opening the chest, where possible. Our structure is a national reference centre for the treatment of

both high-complexity thoracic tumors and rare thoracic tumors that require multidisciplinary expertise. Specifically, it has large experience in mediastinal surgery (with vascular reconstruction), thoracic wall surgery, metastases surgery (with lung tissue sparing), sarcoma surgery, esophageal surgery, and pediatric surgery. The close cooperation with anesthetists and resuscitators has allowed for excellent results over the years in terms of patient safety, even in such complex surgery. Surgery can sometimes be preceded by a complex diagnostic phase or require pre-operative treatment. It is therefore important that the Patient is evaluated, at diagnosis, by all specialists who will participate in their care pathway. For this reason, the Multidisciplinary Thoracic Oncology Group has been active since 2011, bringing together thoracic surgeons, oncologists, and radiation oncologist highly specialized in thoracic pathology, radiologists (specialized in thoracic pathology, lung cancer screening, and interventional methods), endoscopists, pulmonologists, anatomopathologists, and nuclear medicine physicians on a weekly basis to define the best diagnostic and treatment strategy for each case, in light of international protocol indications. Patients who are candidates for surgical intervention are promptly included in a dedicated pre-hospitalization pathway for both preoperative clinical and radiological examinations and a prehabilitation pathway within the ERAS (Enhanced Recovery After Surgery) protocol, aimed at ensuring optimal recovery and an early and safe return to daily activities after operation. Specifically, this protocol may include a comprehensive functional evaluation including preoperative physiotherapy, assessment and correction of nutritional needs, correction of tumor-related chronic anemias, and pain control.

During hospitalization, within the ERAS protocol, the patient is assisted by a specialized nursing team according to an organizational model of personalized assistance (identification of the primary nurse). Furthermore, in the context of research, dedicated Research Nurse support is provided for all patients participating in clinical trials. Clinical Research Over the years, the research vocation of the Thoracic Surgery Unit has translated into participation in multiple research projects, with several publications in international journals with impact factors (link publications*). Specifically, our Structure deals with: · clinical research, by virtue of the large case series accumulated over decades and cooperation with other disciplines and with other Italian and International centers for the creation of multicentric projects and databases; · translational research (thanks to intense collaboration with the experimental oncology group that also focuses on lung cancer) with multiple innovative research lines in the early diagnosis of lung cancer that combine the use of biomarkers in the blood with the use of spiral CT. Excellence also means continuous training, without which any result cannot be maintained over time. For this purpose, Thoracic Surgery annually offers a structured ECM accredited training program dedicated to Doctors and focused on multidisciplinary management and evaluation. Collaborations The Complex Structure Thoracic Surgery also provides its expertise within existing collaborations with: - IRCCS Policlinico San Donato - Cardiac Surgery for the surgical treatment of complex mediastinal neoplasms requiring cardiovascular reconstruction or extracorporeal circulation; - IRCCS Ospedale San Gerardo dei Tintori di Monza (Complex Structure Plastic Surgery) for functional brachial plexus surgery; - IRCCS Istituto Neurologico "Carlo Besta" for the treatment of The Thoracic Surgery Unit of the National Cancer Institute deals with the treatment of tumors of the lung, mediastinum, thoracic wall, and esophagus. It belongs to one of the longest-standing surgical schools in Italy. It was founded in the 1980s by Professor Ravasi and was the first nationally to deal exclusively with oncological Thoracic Surgery. Since 2024, it has been directed by Dr. Piergiorgio Solli. It combines a high technical and assistance level, a strong vocation for research, and an intense training program, with the aim of providing effective and safe care pathways carried out by highly specialized personnel, attentive to the needs and history of the Patient. Surgery is performed by minimizing the invasiveness of the surgical procedure. In adherence to this principle, surgical incisions have always respected all thoracic musculature. Today, thanks to the extensive experience gained in video-assisted (VATS) and robot-assisted (RATS) techniques, the invasiveness of the surgical procedure has been further reduced, and pulmonary and mediastinal resections are performed without opening the chest, where possible. Our structure is a national reference centre for the treatment of

both high-complexity thoracic tumors and rare thoracic tumors that require multidisciplinary expertise. Specifically, it has large experience in mediastinal surgery (with vascular reconstruction), thoracic wall surgery, metastases surgery (with lung tissue sparing), sarcoma surgery, esophageal surgery, and pediatric surgery. The close cooperation with anesthetists and resuscitators has allowed for excellent results over the years in terms of patient safety, even in such complex surgery. Surgery can sometimes be preceded by a complex diagnostic phase or require pre-operative treatment. It is therefore important that the Patient is evaluated, at diagnosis, by all specialists who will participate in their care pathway. For this reason, the Multidisciplinary Thoracic Oncology Group has been active since 2011, bringing together thoracic surgeons, oncologists, and radiation oncologist highly specialized in thoracic pathology, radiologists (specialized in thoracic pathology, lung cancer screening, and interventional methods), endoscopists, pulmonologists, anatomopathologists, and nuclear medicine physicians on a weekly basis to define the best diagnostic and treatment strategy for each case, in light of international protocol indications. Patients who are candidates for surgical intervention are promptly included in a dedicated pre-hospitalization pathway for both preoperative clinical and radiological examinations and a prehabilitation pathway within the ERAS (Enhanced Recovery After Surgery) protocol, aimed at ensuring optimal recovery and an early and safe return to daily activities after operation. Specifically, this protocol may include a comprehensive functional evaluation including preoperative physiotherapy, assessment and correction of nutritional needs, correction of tumor-related chronic anemias, and pain control.

During hospitalization, within the ERAS protocol, the patient is assisted by a specialized nursing team according to an organizational model of personalized assistance (identification of the primary nurse). Furthermore, in the context of research, dedicated Research Nurse support is provided for all patients participating in clinical trials.