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One of the tragic ironies of modern medicine is that the therapies enabling us to survive grave illnesses can sometimes lead to devastating complications. Richard Monti, now 64, learned that lesson after being diagnosed with metastatic kidney cancer at another hospital system in 2018. To combat its spread, he underwent chemotherapy and immunotherapy, had his diseased kidney and part of a lung removed, and then surgery on his right leg to remove cancer and strengthen residual bone, followed by a course of radiation therapy. But the targeted beams damaged Monti’s shinbone, triggering a painful fracture near the knee that simply wouldn’t heal.

Monti had surgery to repair the break in 2022. However, he developed an infection afterward that quickly spiraled into sepsis, a life-threatening condition that occurs when the immune system overreacts to a threat. Monti spent more than a month in a coma, during which he underwent further surgeries to clean out necrotic bone and tissue. When he awoke, doctors delivered wrenching news to him and Erin, his wife of 20 years: They couldn’t save his leg while continuing to treat his cancer. The only safe option was to amputate the limb above the knee.

For Monti, a real estate developer and father of six grown children from Lloyd Harbor, New York, the prospect was unthinkable. “I’m the type of guy who needs to move,” he says. “My legs and my feet make my brain go.”

Seeking a second opinion, he was referred to Nicola Fabbri, MD, an internationally recognized expert in limb-sparing surgery for bone cancer who had recently joined ���ϸ����� Langone Health as chief of the Division of Musculoskeletal Oncology Surgery in the Department of Orthopedic Surgery. The connection proved a fortuitous one. “The first thing Dr. Fabbri said when examining my leg was ‘We don’t just cut off limbs,’” Monti recalls.

Dr. Fabbri’s preference to preserve rather than amputate when possible is supported by science. Research has shown that survival rates for patients who receive reconstructive surgery paired with cancer treatments are equal or superior to those who undergo an amputation. Deciding who is a good candidate for the limb-sparing approach, however, requires careful assessment. With three decades in the field, Dr. Fabbri is uniquely skilled at making such medical judgments and charting a way forward.

“For a cancer originating in the bone that can be cured by eradicating the primary tumor, an argument can be made for amputation,” says Dr. Fabbri, director of the Extremity Sarcoma Program at Perlmutter Cancer Center. “But with metastatic cancer that has spread to bone, amputation is seldom advisable, because you’re sacrificing a limb without actually curing the disease.”

In Monti’s case, the calculations were far from straightforward. On the plus side, he was physically robust, and his type of kidney cancer often responds well to immunotherapy and a targeted drug that his medical oncologist had prescribed. On the minus side, his leg was in bad shape. The bone was deformed, held together with cement and a metal plate, and the surrounding soft tissue was tender and inflamed. “Treating previously irradiated areas is one of the most difficult surgical challenges, greatly increasing the risk of complications,” says Dr. Fabbri. “And prior infection adds to that risk.”

After consulting with colleagues in musculoskeletal oncology, plastic surgery, and radiation oncology, Dr. Fabbri proposed a “stepwise” strategy. First, they would place Monti’s leg in a special brace, extending from the pelvis to the ankle, that would enable him to use crutches more easily and stand without pain. Meanwhile, he could continue the ongoing therapy to treat the cancer. Once his tissue healed, Dr. Fabbri and his team would perform a complex knee and tibia reconstruction to restore some measure of normal mobility. “He told us there was no guarantee the plan would work,” Monti says. “But Erin and I believed in him, and we never thought of giving up.”

Monti wore the brace for the next 14 months. Finally, at a follow-up appointment, Dr. Fabbri asked whether he was ready for the next step. Monti raised both thumbs and smiled.

On October 17, 2023, Monti was wheeled into an operating room at Tisch Hospital for the eight-hour procedure. Working with microsurgeon Pierre B. Saadeh, MD, the Lawrence D. Bell Associate Professor of Plastic Surgery at ���ϸ����� Grossman School of Medicine, and a squad of specially trained nurses, techs, and anesthesiologists, Dr. Fabbri removed the plate and cement from the previous repair attempts. The surgeons attached a knee implant to the tibia and femur, fixing it in place with titanium stems. They cut away a stretch of ruined bone and replaced it with a customized metal prosthesis. Then, they stitched a flap of tissue from Monti’s calf over their handiwork and sent him off to begin his recovery.

Two weeks later Monti returned home to Long Island, where he sweated through daily physical therapy sessions in his basement gym. His postoperative pain, severe at first, dissipated within a month. By Thanksgiving, he was walking with a cane, and at Christmastime, he sent Dr. Fabbri a video showing himself strolling unaided along a beach in Miami—where his youngest daughter, also named Erin, had started nursing school, inspired by the experience of caring for her dad.

Monti’s limp is barely noticeable, and he is back to living a happy, busy life. He loves cooking for family gatherings, riding his bike along the trails that begin in his spacious backyard, and working unimpeded on real estate renovation projects, directing them from 25-foot-high scissor lifts with no concerns.

“It’s hard to put my gratitude into words,” Monti says. “Dr. Fabbri and his team performed a miracle. They gave me my life back.”

Dr. Fabbri, for his part, credits Monti for the miracle. “I’ve always been an optimist, or else I wouldn’t be a cancer surgeon,” he says. “But Mr. Monti’s outcome has exceeded my expectations. I recently told him, ‘If I ever get sick, I want to have a few vials of your serum, because you are supernatural.’”