Lorenzo Spaggiari, MD – PhD
Chief of Lung Cancer Program, European Institute of Oncology
Chief of Division of Thoracic Surgery, European Institute of Oncology
Full Professor of the University of Milan
Professor Lorenzo Spaggiari is a specialist in thoracic neoplasms treatment, starting from diagnostic procedure to minimally invasive approach and advanced and complex surgery. His clinical activity includes lung and mediastinal neoplasia, neoplasm of the esophagus, pleura and the chest wall. Professor Spaggiari from 1998 to 2017 performed more than 4600 operations of thoracic surgery at European Institute of Oncology. His commitment is also directed to convey his experience to student of several Italian and international University with education lectures and mentoring medical and doctoral students, residents and fellows.
Professor Spaggiari clinical and translational researches are focused on thoracic oncology, with diagnostic and therapeutic purpose. He has been principal investigator (PI) and co-PI for lung cancer early diagnosis projects, such as “Continuous Observation of Smoking Subjects” (COSMOS) study, started in 2000, which assessed low-dose computed tomography efficacy for nodules detection on more than 5000 at risk subjects. Moreover, he started in 2012 the evaluation of electronic nose efficacy to detect lung cancer as a rapid, economic and non-invasive alterative for early diagnosis. Regarding surgical studies, he has been involved in comparing robotic thoracic surgery with standard thoracic surgery evaluating quality of life, postoperative mortality and pain. He has been co-PI of several studies regarding multidisciplinary treatment of locally advanced lung cancer, thymoma and mesothelioma. Finally, he has developed stem cells protocol for bronchial repair: thanks to this approach was possible to successfully treat for the first time a patient suffering from bronchial fistula after right pneumonectomy for cancer.
His international engage develops through different important roles like: he is Vice-Direct of Thoracic Oncology Working Group of the European Association of Cardio-Thoracic Surgery and Faculty of Lung and other Thoracic Tumors board of the European Society for Medical Oncology.
Division of Thoracic Surgery
The Division of Thoracic Surgery efforts are concentrated to give the best cure option to lung cancer patients. For this reason, the Division adopts the most advanced techniques currently available for the treatment of thoracic neoplasms, with a particular specialization in the multidisciplinary management of primary lung cancer and lung metastases. Other areas of expertise are the oncological pathology of the mediastinum, pleura, esophagus and thoracic wall.
As certified by the Italian National Agency for Regional Healthcare Services (AGENAS) of the Italian Ministry of Health, IEO Thoracic Surgery Division is one of the most important in Italy and Europe, with the highest number of interventions in Italy with a 30-day mortality at the lowest (0,53% for 2017), even with a large number of highly specialized interventions in advanced and complex diseases in patients with compromised cardiorespiratory function.
The surgical skills of the Division of Thoracic Surgery ranging from the minimally invasive treatments to the advanced and savage surgery. Minimally invasive treatments, with robotic or video assisted approach, are offered for to patients with limited diseases. Robotic assisted surgery determined less bleeding and need for transfusions, increased patient safety and allows to reduce the post-operative hospitalization and pain. This approach guarantees to minimize trauma surgical incision thus favoring a faster functional recovery of the patient. On the other hand, the Division has a significant experience in the treatment of locally advanced lesions, also after inductive treatments or involving large demolition and resection extensions to organs adjacent to the lung. IEO Thoracic Surgery Division has a relevant experience on pleuropneumonectomies, also with invasion of the superior vena cava, of the hull, of the left atrium and of the aorta. The oncological field of intervention involved mediastinal tumors, pleural tumors and in particular mesotheliomas, primary tumors of the thoracic wall or the esophagus.
The Division is also committed to offer the most rapid and minimally invasive diagnosis with the interventional pneumology services. The programme started in 2010 and is able to provide a diagnostic and therapeutic service at the forefront of pulmonary medicine. With more than 700 operational bronchoscopy procedures at year, mostly with EBUS-TBNA (trans-bronchial ultrasound) approach that does not require general anesthesia or intubation, guarantee high diagnostic accuracy combining with patient safety and comfort. Other procedures performed by the interventional pneumology services are rigid bronchoscopy of the major airways obstructed by intra-luminal cancer to reanalyze or to position endo-bronchial stents and pleuroscopy to explore the pleural cavity.
All the Division’s clinical activities are integrated with the ones of the Division of Thoracic Oncology inside the IEO “Lung Program”, to obtain the best dedicated and personalized therapeutic strategies for each patients. The multidisciplinary approach allow to formulate the appropriate treatment pathway in the shortest time possible.
Finally, the Division has a strong research vocation, which is mainly developed in four areas: early diagnosis, clinical area, molecular biology and chemoprevention. Some of the clinical trial, several of which founded by competitive grant, are:
- Early stage lung cancer detection program: begin more than 10 years ago with low dose computed tomography and recently implemented by biological fluids analysis to identify any biomarkers useful. Moreover the Division was one of the first in Italy to evaluate experimental device integration, the so called electronic nose. The e-nose was tested in IEO cohort of patients and showed great potentiality to identify distinct characteristics in the exhaled breath of undiagnosed patients with lung cancer.
- Regenerative medicine program has been recently developed with excellent experimental and clinical results which evaluated post resectional bronchopleural fistula closure by autologous mesenchimal stem cells endoscopic transplantation. The use of stem cells with an intrinsic renewal potential and differentiation towards different cell lines, inoculated via bronchoscopy at the fistulization site, promoted significantly the healing of the fistula. This approach could help patients with fistula to avoid any complication and faster the recovery.
- miRNAs profiling with the minimally invasive bronchoscopy method was compared with the most invasive surgical method of mediastinoscopy. This study allowed to demonstrate how the miRNA profile for lung cancer can be evaluated on bronchoscopy sampling in a completely overlapping of the traditional approach but with an inferior invasiveness. miRNA are now be evaluated also to unraveling signatures of chemoresponse of locally advanced lung cancers or as early recurrence markers.
- Robotic assisted surgery potentiality: Comparing of video-assisted thoracoscopic and robot-assisted thoracoscopic lobectomies to evaluate the capability of both procedures to perform an adequate and safe radical lymphadenectomy and the subsequent oncological results in term of recurrences and overall survival. The robotic approach is currently under evaluation also in the treatment of locally advanced non-small-cell lung cancer after induction therapy, comparing postoperative complications and oncological outcome.
These researches and important clinical results have been published on international recognized journal: the Division published 302 articles from 2005 to 2018 with a total Impact Factor of 1252.81.
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