In a large pot, bring salted water to a rolling boil and add the paccheri pasta. Cook according to package instructions until al dente, usually around 10-12 minutes, ensuring they remain slightly firm when bitten. Once cooked, reserve about 1 cup of pasta water, then drain the pasta and set it aside while you prepare the sauce.

In a large, deep skillet, heat about 2 tablespoons of extra virgin olive oil over medium heat. Add the sausages, breaking them into bite-sized pieces with a wooden spoon. Sauté for around 5-7 minutes, or until the sausages are browned and cooked through.

Once the sausages are browned, add 3-4 minced garlic cloves to the skillet. Stir continuously for about 1-2 minutes until fragrant.

Pour in the juice and zest from 1-2 fresh lemons, stirring to combine. Reduce heat to medium-low, then add 1 cup of heavy cream, stirring continuously. Let it gently simmer for about 3-5 minutes until the sauce thickens slightly.

Add the drained paccheri pasta to the skillet, tossing to coat thoroughly with the sauce. If too thick, gradually add reserved pasta water until desired consistency is achieved.

Stir in ½ cup of grated Parmesan cheese along with salt and pepper to taste. Mix until the cheese has melted and the sauce is creamy, then remove from heat. Let it rest for a minute before serving.