-
News & Events
In this episode, Gloryren specially invited Prof. Donati, a World-class Master of Orthopedic Oncology, for an exclusive interview. Prof. Donati currently serves as the Director of the Unit of Clinical Orthopedics and Traumatology III (Department of Orthopedic Oncology) at Rizzoli Orthopaedic Institute in Italy, and is also an Associate Professor in the Department of Biomedical and Neuromotor Sciences at the University of Bologna. Rizzoli Orthopaedic Institute is ranked as one of the top ten orthopedic institutions by Newsweek in the world in 2025. With over a century of experience in the treatment of bone and soft tissue tumors, it is one of the most famous bone tumor centers in Europe and even around the world. Prof. Donati’s mentor was Prof. Mario Campanacci, which was the pioneer of bone tumor research and classification, as well as an outstanding scientist and orthopedic surgeon. During the interview, Prof. Donati shared the influence his mentor had on him; introduced why Rizzoli Orthopaedic Institute was honored as the most renowned bone tumor center over the Europe; shared how to build trust with patients when dealing with complex cases of bone tumor; offered insights on how doctors can keep up in the rapidly developing field of bone tumor; and provided his advice for young Chinese doctors who work on bone tumor.
1. We know that you are a world-renowned expert in bone tumor, could you briefly introduce yourself first and share with us why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in bone tumor?
I was born in 1958 in a small town close to the seashore. Then I moved for the medical school to Bologna. And in Bologna, I needed to have my doctoral thesis done in 1982 before graduating. And at the time, Rizzoli Institute was one of the 10 institutes in Italy appointed to follow the patient for treatment and research, particularly for research, and it was granted for that. So I believe at the time that, to be in Rizzoli would be a good choice for me and to be also of course, an orthopedic surgeon.
So I met Prof. Campanacci from the beginning. He was an important mentor, an important guy in the field of the musculoskeletal tumor treatment. And he was also a very nice guy, so I really felt that probably it was my place. And I did the thesis there and I did the residency and I remained there. So he was really involved in the tumor. So I did the same for all my life. Actually, I took the place of Prof. Campanacci who was the chief of the unit that takes care about musculoskeletal tumor.
2. We know that the Rizzoli Orthopaedic Institute is one of the most famous bone tumor centers in Europe, could you briefly introduce this hospital and the Dept. Of Orthopaedic and Trauma Surgery III (Orthopaedic Oncology)” that you chair?
Yes, of course. Rizzoli has a long story, is one of the hospitals that was dedicated to the orthopedic wholly. It was built in 1896 by Prof. Rizzoli that at that time was a general surgeon and he had the problem of the young guys, the children with deformities. So he got this place that was an ancient monastery from the city hall, and he paid himself to renew everything and do a hospital there. So since then, a lot of people having similar problem, orthopedic problem came to Bologna and specifically in Rizzoli. So Rizzoli during the time developed all the subspecialties in orthopedics, of course, also in tumors, even though tumors has not been recognized very well since the seventies, the eighties.
Prof. Campanacci was the first taking the chair to treat and follow those patients and when he was able to make the diagnosis because he was also a pathologist, he was one of the pioneers in this field all over the world. So, Rizzoli became really famous for this treatment in particularly the unit that I'm directing.
We have a group of units. We have the unit that I am directing that is devoted in general to the musculoskeletal tumors. But we have also a unit that is devoted to the spine surgery, taking care of tumors in the spine, primary and secondary tumors. Then we have the oncology group that is another little unit that takes care of the patient with bone and soft tissue tumors, children and adults. Then we have, as I told you before, the radiology department, that half of that is devoted to follow our patients for the diagnosis and the treatment. And we have the pathologists and the physical therapists and the nurses, all together there are not less than 100 doctors and all the nurses, including all the people taking care of our patients, the case manager or the data manager. They are really important now to do research in our countries.
2.1 What are the unique advantages of your department in the treatment of bone tumors?
Take care of musculoskeletal tumors is not an easy task and you cannot do yourself even though you are a good surgeon, you have to do it in a multidisciplinary team. And so already at the time of Prof. Campanacci, we could have the medical oncology in Rizzoli, we could have the pathology as I said, Prof. Campanacci was a pathologist, but then soon other pathologists have been trained to do the musculoskeletal pathology and the radiologist too for the diagnosis. So all the CT guided needle biopsies and any other type of treatment, basically actually minimally invasive treatment and then of course physical therapists nurses that are devoted to this field.
So in this setting, we could grow up and having a real department taking care of our patients. In the medical oncology unit, we also have a school for our pupils or our children affected by tumors. We have the possibility to host and house the parents. So it's something that has been growing up during the time.
2.2 What are the future research priorities for you and your team?
Coming to the question of what are our goals of research now? The research in Rizzoli is quite well developed. As I told you before, since eighties when we had been appointed as a research institute in Italy, we have several research labs including the musculoskeletal tumor research lab. And we personally try actually to focus on the personalized treatment not only in the surgical way but also in the medical way, because actually every patient more and more needs attention and moreover, a personalized treatment for them. This is not even under a surgical point of view. This is not a real standard surgery.
Now we have a great deal with the soft tissue tumor that until twenty years ago they were not so followed in Rizzoli, and actually more recently for the metastases, the metastases from the solid organs that until 10 or 15 years ago they were killing the patient very soon. Now with the new drugs, the patients are really surviving longer and we as orthopedic surgeons when there is a bone metastasis, we have the task to give to the patient the better quality of life possible.
3. Who have been your greatest influences? What have they taught you and how have they inspired you?
You know, when you are in a highly competitive, or professional environment, like in medicine, but in any other places like this, most of the people are resembling quite selfish. They are just thinking about themselves, their career, their opportunity to grow up. When I met Prof. Campanacci, he was a man who was really thinking about doing the job in the best way possible. If you come to Rizzoli, there is a statue of Prof. Campanacci that we built up after his death. And under the statue, there is a writing in which he said that, the most important things are to follow the patient first, to give merit to the people that are striving to do it, and to collaborate together through the teamwork, the third, and finally the international relationship. So this was the principles that Prof. Campanacci brought out, and we inherited this type of principle.
Then I had the chance during my career to follow other main doctors in the world. I spent one year in the States with Prof. Mankin and Prof. Frank Sim in Mayo Clinic, Prof. Mankin at the Harvard Medical School. And I remember when Prof. Mankin used to tell me, “Davide, you are not to work to be a good surgeon, you have to work to win the Nobel Prize.” That means that you have to do the most you can to give your best and give the best to the patients.
4. In the MDT model for bone tumor cases, how does the multidisciplinary collaboration conducted by your team? Could you share some case-based experiences in this regard?
You have to take in mind that Rizzoli is an orthopedic hospital, so most of the patients, they come to us for having a surgical treatment. But as I told you before, the surgical treatment means that, you have to collaborate and work together with some other people, and the other people usually in a setting like Rizzoli, they rely upon you, the surgeon. So we do the multidisciplinary meeting and I have, as a chief of the unit, to take the latest decision, the final decision, to give the best treatment, both in terms of surgical but also medical or radiotherapy or whatever for the patient. So this is the usual way in which you should take your responsibility when you are a chief.
We are curious that in which scenario you will do the MDT collaboration?
We, of course, have primary cases, so I would say standard cases in which the treatment is already considered as a standard one, we don't discuss much for those cases. The cases are discussed as many other cases in which we have complications, we have a recurrence of the disease in the field of the surgery or elsewhere cases in which the chemotherapy is not enough effective, so we have to change cases at the final hand. We have to involve the palliative doctors or sometimes cases in which we have the lung metastasis, so we involve the chest surgeon. Sometimes we have also to invite people, the general surgeon, the maxillofacial surgeon because there are many different questions that can be raised for a complicated case. Also in these cases, we have to take a decision and the final decision usually is about the director of MTD that actually is the orthopedic surgeon, it's me.
5. How do you build trust with patients and reach a favorable treatment plan when faced with complex bone tumor cases? Could you please share some tips and tricks for communication with patients.
First of all, you have to take in mind that the first impression that the patient has is that, the outpatient clinic, the first contact with you. And in the first contact, it is very important what you transmit to him. And first of all, you don't have to fear of your job, so there are doctors that are not enough sure of themselves, and then transmit uncertainties to the patient. This is, of course, a matter of your experience, your capacity to research and attend to the patient, but you don't ever transmit some uncertainties to the patient. Second, you have to give them the better surgery, and you have to explain very clearly which surgery you will give them without taking too many complications and whatever. Third, the patient should perceive that you are the correct person to be treated by. So these three rules are really important. You have to transmit to the patient the idea that he is in the best place ever possible to be treated for their diseases.
So then it is very important that you follow the patient. Maybe if you are very busy, you cannot follow the patient after the surgery during the hospital stay, but you have to be present to the patient sometimes in the follow-ups because the patient needs to be treated by one person, even though they know that you are not able to follow everybody every time. But they have to get the perception that you are behind, your collaborator that are facing them.
6. In the field of bone tumor treatment, medical knowledge and treatment standards/technologies are constantly developing. How do you think surgeons could keep up with the latest clinical advancements and scientific research findings in this field?
First of all, for the young guys, the first suggestion is that you have to review the series of patients, so you learn much more from reviewing the series of patients than in any discussions. Because what is going to make yourself sure what you do is that, you have a good knowledge. And the literature is not enough. If you read the literature and you are not experienced in reviewing your patient, you don't have enough questions to put to the literature, so this is the first. The second thing is, don't worry about how much you practice surgery. For instance, in Italy we have a lot of doctors and the young doctors, basically, during the residency, they are not really the first operator during the surgery. But in any case, you have to review every patient, to follow all the patients, and to study at home the day before the operation, even though you are not in charge to do it, because this is the only way to see and learn from what you see. And then there will be the time in which you will do it personally and you will be able to have clear ideas. Clear ideas in our job is the main thing that you need. Prof. Campanacci used to say, 60% of the job is what you have to do, the diagnosis and the idea of what you do in the operating room, then only 40% is the ability to use your hand. The hand can be practiced, but the head, if you don't practice your head, your mind, your brain during the learning period, you end up when you are 40, 45 that you'll never learn again because you just do the things that you know you are not able to improve.
What is of paramount importance is to do research. This is something that you have to do always when you are young, when you are a good doctor and when you are about to finish your career, because otherwise you end up to doing the things that you already are able to do. And basically, most of the time this is not the correct way to improve and give the best to your patient.
For instance, in our unit, as I told you before, Rizzoli is a research institute. Now, our unit, we have people helping us, the data manager, and we do constantly meeting about the science, the research and reading the literature, reviewing. And I want everybody in my unit taking care of some aspects of the bone tumors. So there are people that are following the children, soft tissue metastases and whatever. And we want to push the people to publish, to make paper about what they review.
Just to tell you one thing that is related again to Prof. Campanacci. When I had the need to speak with him for any type of problems and I got into his office, he always said, “You cannot get into my office if you don't have a paper to review with me.”So it's because he pushed us to do exactly the same to be involved in the research.
7. As a university professor, chief physician, members of many professional societies, how do you balance the administration, clinical practice, research activities, teaching and personal life?
The tricks is to have a good group working with you. You cannot follow everything. You have to give tasks to the people that is working with you. And in this way, with less strive, you can follow everything. Personally, I became a chief in 2012. And in the beginning, I did a lot of things myself, staying in the hospital all the day long, always tried to follow everything of course. Now I have people that are taking care about any aspect of our job. Besides the part of the research, I don't do much research anymore, I just control what the other people do. I do some of course lectures. I participate to the international meetings. We do courses about tumors and big surgeries in tumors, and the relationship with the companies that produce devices. But 80% of the job has been developed by my collaborators.
8. How is the training of young surgeons for specialization in bone tumor in Italy? What advice would you give to young Chinese surgeons who wish to specialize in this field?
In Italy, there is not a particular training for the bone tumors. Usually you do the residency and if you do the residency in a hospital where there are the musculoskeletal tumor treatment. You can be involved with them. Usually, to have a good expert of tumors, it needs not less than fifteen years. Because it takes long not just to be a surgeon, as I told you before, but to be a good scientist because treating those patients means also to be able to read the slices, to read the images, to be involved with the research, to be able to review the cases. And this is very important to build up a good scientist, not only a good surgeon.
You don't have to worry if you are not really involved in the surgery in the first few years of your career. You will learn to do it as soon as you will be the first surgeon. But to be a good first surgeon, you need clear ideas of what you have to do. And if you don't have clear idea of what you have to do, you'll never become a good surgeon, even if you are talented with your hands. So this is a really important thing.
9. What would you have been if you had not been a medical doctor?
The curious thing is that I didn't want to be a doctor. I didn't have in my mind during the high school to be a physician. I wanted to be an architect or a singer because I used to play guitar and sing. But in my family, we had my dad that was a doctor and my mother wanted me to be a doctor. So I started the medical school and in the first year it was not really easy to do it, because as you may know, when you are not really directed in that way, in your mind the first examination, they were not so brilliant. Then I want you to remember what Albert Einstein used to say that, “Curiosity is more important than knowledge.” So as far as I'm a curious guy, I got involved in this new field that was the human body, and then year after year, I was much more involved with that. I would change a little bit what Albert Einstein said and is that, curiosity drives you to the knowledge because you need of course the knowledge, but the knowledge is something that come after the need to discover, to see, to acquire new perspective horizons in your life.
10. What are your interests and hobbies outside medicine?
I didn't practice much my hobbies during my life because I was really involved in the job. And as I told you before, something that is not in contrast, my job with my life, even my family, they are really involved in it in the way that they never asked me to be more at home. It was probably useful. Because I spent for a long time, more than ten hours per day in the hospital.
But in any case, you know, as I told you before, some of my lectures are about architecture, historical cities, discovery. And of course, I still play my guitar and I sing sometimes, and I feel that is something that is good for your soul.
In the last years, as I bought a house in the countryside, I became a gardener. You know, I like very much to see the trees grow up and be involved in anything that is growing from the ground. This is my new passion.
