From September 2nd to 6th, 2024, Prof. Donati, the World-class Master of Bone Tumor, the Head of the Orthopaedic Oncology Unit and one of the founders of the Musculoskeletal Tissue Bank of Rizzoli Orthopaedic Institute Bologna, Italy, visited the Shenzhen Second People's Hospital as an international visiting professor, and carried out a series of academic exchange activities in the hospital, including ward rounds, surgical guidance, surgical practice, internal lectures for training, discussions on department management and complex cases, and public lecture, etc.

Unveiling Ceremony of Sino-Euro Communication Center for Bone Tumor

Party Secretary ZENG Hui, Vice President YANG Lei, Director of Dept. Of Bone Tumor Prof. ZHANG Shiquan, the bone tumor team and other medical staff of Shenzhen Second People's Hospital attended the welcome ceremony, and jointly held the unveiling ceremony for the "Sino-Euro Communication Center for Bone Tumor”.

During the welcome ceremony, Prof. Donati introduced that the Rizzoli Orthopaedic Institute was founded in 1896, and Prof. Alessandro Codivilla, the first Director of the Institute, is considered the founder of modern traumatology. Since 1981, the Institute has been recognized as a Scientific Hospital and Care Institute(IRCCS). And there are 54 other hospitals having this recognition and funding in Italy. The Rizzoli Orthopaedic Institute is ranked 5th in the world among Orthopaedic hospitals and 1st in Italy in the year of 2023 from the Newsweek magazine. Prof. Donati hoped that through the sharing, the Chinese colleagues could have a deeper understanding of the history, clinical and scientific activities of the Rizzoli Orthopaedic Institute.

Prof. ZHANG Shiquan, Director of the Department of Bone Tumor of Shenzhen Second People's Hospital, also introduced the situation of the department as well as the main surgical techniques carried out by the department.

Prof. Donati visited the ward of the Dept. Of Bone Tumor.

Internal Lecture

On the afternoon of September 2nd, Prof. Donati gave lectures at the Dept. Of Bone Tumor, in which he shared two academic lectures, “Development of custom pelvic prostheses for the reconstruction of malignant pelvic lesion” and “Surgical Treatment of Bone Metastases”, and participated in the discussion of surgical plan for patients who would underwent surgery on Wednesday. The discussion in the afternoon was very heated, both sides actively interacted with each other and immersed themselves in the discussion without realizing the passage of time. After the discussion was over, both sides looked forward to exchanging more ideas in the following days.

MDT Discussion on Complex Bone Tumor Cases

The MDT Discussion on Complex Bone Tumor Cases is held every Tuesday morning at the Shenzhen Second People's Hospital, where a team of specialists from the Dept of Bone Tumor, the Dept of Pathology, the Dept of Radiology, and the Dept of Imaging gathered together to discuss complex bone tumor cases. Today Prof. Donati joined the MDT discussion, and discussed with them a number of difficult bone tumor cases, such as osteosarcoma, synovial sarcoma, and fibroma, etc.

Bone tumor team reported the patient's condition in English, then the imaging experts and radiologists interpreted the patient's images in detail, while Prof. Donati also provided his opinion on the images and made a diagnosis, and then the pathologists presented the pathological report and their conclusions, and finally experts from multiple disciplines collaborated to discuss the treatment plan together.

Prof. Donati discussed each case with the MDT team in depth in terms of method of biopsy, medication, choice of prosthesis and surgical approach, and shared many new technologies and progresses of the diagnosis and treatment of bone tumor with Chinese colleagues.

In the afternoon, Prof. Donati attended the Specialist Outpatient Clinic together with Director ZHANG Shiquan of Dept of Bone Tumor. A number of patients came here by Prof. Donati’s fame. Prof. Donati answered each patient's questions in detail and provided suggestions for follow-up treatment.

Surgical Guidance

In the morning on September 4th, Prof. Donati arrived at the operating room of Shenzhen Second People's Hospital. The first surgery of the day was performed on a patient referred from another hospital with Pigmented Villonodular Synovitis(PVNS), and Prof. Donati, together with Dr. LI Wei and Dr. XU Gang of the Dept of Bone Tumor, performed a soft tissue mass resection on the patient, which went smoothly and was completed in less than an hour.

Prof. Donati then observed a giant cell tumor resection on the right knee and knee replacement surgery performed by Director ZHANG Shiquan. As the tumor was very large, the surgery was difficult and there was a lot of bleeding during the operation, Prof. Donati shared some tips on how to handle bleeding during the operation.

The third surgery was the resection of chondrosarcoma of the left calcaneus. Prof. Donati discussed with the bone tumor team about the surgical incision, management of vessels, and the method of filling with bone cement after tumor resection, and shared that when doctors deal with this kind of cases in Italy, they also use bone cement, but they do not put plate for reconstruction because it will increase the rate of postoperative infection.

Through one day's surgery, Prof. Donati had much more understanding of the surgical techniques carried out by the bone tumor team, and prepared several case sharing slides based on their actual situation and interest, which he said could ensure a more targeted exchange in the following days, and could bring practical help to the bone tumor team.

Lecture on Bone Tumor

In the morning of September 5th, the bone tumor team prepared several cases about aneurysmal bone cysts (ABCs) to discuss with Prof. Donati, who shared his treatment suggestions one by one. During the exchange, the situation of the three patients from yesterday’s surgeries was also discussed.

Prof. Donati then gave a lecture titled “Aneurismal bone cyst treatment by minimally invasive surgery with demineralized bone matrix and bone marrow concentrate”. Prof. Donati introduced that this type of disease is more frequently seen in children and young adults, and that curettage and bone grafting has been considered for many years the gold standard procedure since it provides enough osteogenic stimulus to enhance healing. Although the bone grafts potentially promote new bone formation inside the cyst, the rate of recurrence is 21%. Further, donor site morbidity has reduced the appeal of this procedure for some surgeons. Thus, there was a need for less invasive treatments considering the benign and self-limited nature of the lesion. Some people proposed that the injection of bone marrow (BM) alone or in combination with demineralized bone matrix (DBM) could be an alternative to steroids for treating ABCs, or arterial embolization could be another treatment option.

During the lecture, Prof. Donati shared several latest literature on injection treatment for ABCs, and also shared the result of one of their clinical studies on the minimally invasive treatment for ABCs by injecting DBM as well as autologous BMC and platelet rich fibrin (PRF), which is that the success rate is 76% and there is no local complication.

At the end of the lecture, Prof. Donati said that although this treatment is promising, longer follow-up and clinical studies are needed to establish the value of this treatment in ABCs. Through Prof. Donati's lecture, the bone tumor team gained a more comprehensive understanding of the diagnosis and treatment of ABCs, and it also brought new international visions to the team. After the lecture, Prof. Donati provided detailed expert consultation service for several patients who specially came to the department.

Difficult Case Discussion and Department Management Training

On the morning of September 6th, Prof. Donati arrived at the department and shared two difficult cases of osteosarcoma and chondrosarcoma, and had an in-depth discussion with the bone tumor team. Prof. Donati introduced the global consensus of 300 delegates from more than 50 countries on daily treatment strategy for chondrosarcoma at the Birmingham Orthopaedic Oncology Meeting (BOOM) in January 2024 and suggested that the bone tumor team could benefit from this global consensus to know more cutting-edge advances in the treatment of chondrosarcoma.

After the case discussion, Prof. Donati shared a lecture on “How to manage a bone tumor department”. By introducing the development history of the Bone Tumor Center at Rizzoli Orthopaedic Institute over the decades, Prof. Donati shared his experience in managing a bone tumor department.

He shared that in the 80's, the Bone Tumor Center aimed to save patients' lives, in the 90's it made improvements so as to do it better, from 2000 to 2010, it aimed to avoid complications, and now it has developed into the personalized age, which is dedicated to providing the best treatment plan for each patient.

Prof. Donati shared that a well-functioning Bone Tumor Department should have solid experience in bone tumor gained over the years; be able to treat almost 100 cases per year; have a team that has the ability of operating with many different devices; conduct case reviewing and teaching activities; have multidisciplinary collaborations available and have connection with other main oncology orthopaedic centres (nationally and internationally).

Bone Tumor Master’s Public Lecture

In the afternoon of September 6th, the Bone Tumor Academic Salon of Shenzhen Anti-Cancer Association(SACA) was successfully held in Shenzhen Second People's Hospital, attended by the bone tumor teams from Shenzhen Second People's Hospital, Shenzhen Hospital of the Cancer Hospital, Chinese Academy of Medical Sciences, the Eighth Affiliated Hospital of Sun Yat-sen University, and the University of Hong Kong - Shenzhen Hospital.

Prof. Donati shared an academic lecture on “Limb salvage surgery of bone and soft tissue tumor” and discussed with Chinese colleagues on hot topics such as customized prostheses (pelvic, extendable prostheses), radiotherapy and chemotherapy, anti-infections, and revision surgery.

Afterwards, the Chinese doctors shared their cases one by one, and Prof. Donati gave his ideas and suggestions. At the end of the meeting, Director ZHANG Shiquan, on behalf of the Bone Tumor Team of Shenzhen Second People's Hospital, expressed his heartfelt thanks to Prof. Donati for his guidance during the week and hoped that Prof. Donati could visit Shenzhen again in the future for more academic exchanges.