No one fights lung cancer alone. At Roswell Park Comprehensive Cancer Center, patients have access to the latest advancements in lung cancer surgery.
Here to tell us what to expect when you have lung cancer surgery and what it means to be recognized as a US top performing center in the area of lung cancer surgery is Sai Yendamuri, MD, FACS, Chair, Department of Thoracic Surgery at Roswell Park Comprehensive Cancer Center.
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What to Expect: Lung Cancer Surgery
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Learn more about Sai Yendamuri, MD
Sai Yendamuri, MD
Sai Yendamuri, MD Chair, Department of Thoracic Surgery, Professor of Oncology, Attending Surgeon, Department of Thoracic Surgery and Director, Thoracic Surgery Laboratory.Learn more about Sai Yendamuri, MD
Transcription:
What to Expect: Lung Cancer Surgery
Bill Klaproth (Host): The lung cancer team at Roswell Park follows the clinical practice guidelines in oncology, the internationally recognized standards for clinical policy in oncology, and the most comprehensive, most frequently updated clinical practice guidelines available in any area of medicine when it comes to lung surgery, and here to talk with us about lung cancer surgery at Roswell Park Cancer Institute as part of the What to Expect Series is Dr. Sai Yendamuri, Chair, Department of Thoracic Surgery at Roswell Park Comprehensive Cancer Center. Dr. Yendamuri, thank you for your time. So, when is lung cancer surgery most commonly used? Is it in the early stages or later stages of lung cancer?
Dr. Sai Yendamuri, MD, FACS (Guest): Traditionally, lung cancer surgery was used in the earlier stages, usually Stage 1 and Stage 2, and by that we mean that it's used in patients in whom the cancer has spread either to no lymph nodes or only to the local lymph nodes. However, over the last 20 years or so, increasingly it has been used for cancers that have spread to more of the regional lymph nodes as long as the situation is right for us to deploy surgery in order to affect, potentially cure.
Bill: So, lung cancer surgery generally happens in the earlier stages before it spreads. So, this is before someone would even think about getting chemotherapy?
Dr. Yendamuri: That’s correct. Most of the time when we do surgery it is before chemotherapy except for some select situations. The one where the situation where I said it can be applied to the situation to where the cancer has spread to the regional lymph nodes. In that area, you do chemotherapy first followed by surgery, but in most instances, you're right. We go ahead with surgery first followed by chemotherapy or radiation, if required.
Bill: Okay and then who is a good candidate for lung cancer surgery?
Dr. Yendamuri: So, to be a good candidate for lung cancer surgery, three things have to be satisfied. First, is that the cancer itself has to be in the appropriate stage. That’s Stage 1, 2 or what we call Stage 3a. The second is that the patient should have enough lung function to tolerate surgery because part of lung cancer surgery we do take out a small portion of the lung that’s actually functional. So, if the patient does not have enough reserve to tolerate that loss of function, then they would not be a candidate, but most patients have enough reserve including patients who’ve smoked for several years, and so we are able to offer surgery. The third criteria that the patient has to satisfy is their overall medical condition has to be suitable for them to have general anesthesia. So, as long as these three conditions are satisfied, patients are candidates for lung surgery.
Bill: And Dr. Yendamuri, I imagine then that minimally invasive surgery would help in that, especially if lung function is critical before you go into surgery. So, the minimally invasive types of surgery would help. So can you talk about those, the VATS, Robotic and Pancoast and what are the benefits of each of those?
Dr. Yendamuri: Right, minimally invasive surgery is increasingly becoming the standard of care for all kinds of surgery, and so it is for lung cancer surgery as well. Now, both VATS or video-assisted thoracic surgery or robotic surgery are both different forms of minimally invasive surgery. In the first one, it’s more like laparoscopic surgery where, you know, the kind of surgery people have to have their gallbladders out. So, somewhere between one and three incisions are made and a scope, a telescope, is passed through one and instruments are passed through the others and all the structures that need to be divided are divided using these instruments. The specimen is then placed in a bag and taken out. The same thing when it is done with the use of a robot, of a surgical robot, it’s called robot-assisted surgery. You know, both of these have distinct advantages over what was traditionally done before. That’s open thoracic surgery where a big incision was made, and, you know, either a rib resected or cut and the ribs are spread and go in because patients having minimally invasive surgery, we are able to get them through the surgery even if they have marginal lung function, and they generally tend to recover better with fewer complications.
Bill: That’s amazing, and the new technology is just wonderful. Thanks for sharing that with us Dr. Yendamuri. So, this is the “What to Expect” series. So, for someone preparing for surgery, after surgery, etcetera, what should someone expect in those instances?
Dr. Yendamuri: Right. So, typically, once the patient is deemed a candidate for surgery, we teach them some breathing exercises to give them what we call an incentive spirometry. Essentially, it’s a little device which helps you get some breathing exercises. They usually come to the hospital on the morning of surgery. Gone are the days when people were admitted before. Typically, they show up on the day of surgery, after of course the anesthesiologist has seen them well before, and you know, we’ve dotted all our I’s and crossed our T’s before the patient shows up. The surgery usually takes between three and four hours, and when we are able to accomplish this minimally invasively, which we are able to do 95% of the time, the patient typically doesn’t even go to the ICU. They go to a monitored floor. They stay in the hospital roughly three days and then discharged home. The amazing thing about minimally invasive surgery is most people after this kind of surgery can go home directly. In the past, we would have to send a lot of our patients to a rehab facility or a nursing facility to recoup before they can go home, but minimally invasive surgery has really changed that paradigm, and at home, it takes them anywhere from two to four weeks to sort of feeling completely back to normal. But at the time of discharge, most patients are able to take care of themselves, and need, you know, only minimal support –
Bill: That’s –
Dr. Yendamuri: – from their system.
Bill: That’s amazing, absolutely amazing and good to here. And Roswell Park Cancer Institute has been recognized as a US top performing center in the area of lung cancer surgery. What does that exactly mean, Dr. Yendamuri, to a regular patient? Explain that to us.
Dr. Yendamuri: Right. So, the criteria for top-performing hospitals is made based on a number of things. One is it’s based on infrastructure – it depends on what kind of technology we have; what kind of ICU support we have; how our nurses are, and so on and so forth. The second component is actual performance in terms of how many cases we do, you know, what our outcomes are. You know, what the chance of dying from surgery is, and also, how often they're able to actually get patients home instead of them needing, you know, additional support or rehab or so on, so forth. And one of the reasons we have done so well in any outcomes measure anywhere using different scales is that we tend to perform most of our surgeries, like I mentioned before, about 95% of our operations through minimally invasive means. I think that’s really helped our patients and helped us take better care of them.
Bill: Ummm hmmm. And what did you do to achieve this? What kind of steps did you take?
Dr. Yendamuri: So, this is a program that has been built over the last 15 years. You know, starting in about 2002, 2003, we started adopting minimally invasive techniques, and over time, we’ve amassed a great deal of experience doing even complex resections through small incisions. We have, for example, one of the largest facilities in the country for doing minimally invasive pneumonectomies. That is taking out the entire lung through a small incision. We’ve done other complex resections, such as taking out portions of chest wall when the tumor invades the chest wall, and we’ve managed to do that thoracoscopically. So, it’s accumulated experience by the team, not just the surgeons, but the anesthesiologists, nurses, ICU staff, everyone in handling patients with these complex conditions, with the minimum of surgical trauma that has enabled us to get to this level of expertise.
Bill: Well, congratulations again. It’s been a 15-year journey but definitely well worth it. Dr. Yendamuri, thank you again for your time today and talking to us about lung cancer surgery as part of the What to Expect Series. For more information, you can visit roswellpark.org. That's roswellpark.org. You're listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I'm Bill Klaproth. Thanks for listening.
What to Expect: Lung Cancer Surgery
Bill Klaproth (Host): The lung cancer team at Roswell Park follows the clinical practice guidelines in oncology, the internationally recognized standards for clinical policy in oncology, and the most comprehensive, most frequently updated clinical practice guidelines available in any area of medicine when it comes to lung surgery, and here to talk with us about lung cancer surgery at Roswell Park Cancer Institute as part of the What to Expect Series is Dr. Sai Yendamuri, Chair, Department of Thoracic Surgery at Roswell Park Comprehensive Cancer Center. Dr. Yendamuri, thank you for your time. So, when is lung cancer surgery most commonly used? Is it in the early stages or later stages of lung cancer?
Dr. Sai Yendamuri, MD, FACS (Guest): Traditionally, lung cancer surgery was used in the earlier stages, usually Stage 1 and Stage 2, and by that we mean that it's used in patients in whom the cancer has spread either to no lymph nodes or only to the local lymph nodes. However, over the last 20 years or so, increasingly it has been used for cancers that have spread to more of the regional lymph nodes as long as the situation is right for us to deploy surgery in order to affect, potentially cure.
Bill: So, lung cancer surgery generally happens in the earlier stages before it spreads. So, this is before someone would even think about getting chemotherapy?
Dr. Yendamuri: That’s correct. Most of the time when we do surgery it is before chemotherapy except for some select situations. The one where the situation where I said it can be applied to the situation to where the cancer has spread to the regional lymph nodes. In that area, you do chemotherapy first followed by surgery, but in most instances, you're right. We go ahead with surgery first followed by chemotherapy or radiation, if required.
Bill: Okay and then who is a good candidate for lung cancer surgery?
Dr. Yendamuri: So, to be a good candidate for lung cancer surgery, three things have to be satisfied. First, is that the cancer itself has to be in the appropriate stage. That’s Stage 1, 2 or what we call Stage 3a. The second is that the patient should have enough lung function to tolerate surgery because part of lung cancer surgery we do take out a small portion of the lung that’s actually functional. So, if the patient does not have enough reserve to tolerate that loss of function, then they would not be a candidate, but most patients have enough reserve including patients who’ve smoked for several years, and so we are able to offer surgery. The third criteria that the patient has to satisfy is their overall medical condition has to be suitable for them to have general anesthesia. So, as long as these three conditions are satisfied, patients are candidates for lung surgery.
Bill: And Dr. Yendamuri, I imagine then that minimally invasive surgery would help in that, especially if lung function is critical before you go into surgery. So, the minimally invasive types of surgery would help. So can you talk about those, the VATS, Robotic and Pancoast and what are the benefits of each of those?
Dr. Yendamuri: Right, minimally invasive surgery is increasingly becoming the standard of care for all kinds of surgery, and so it is for lung cancer surgery as well. Now, both VATS or video-assisted thoracic surgery or robotic surgery are both different forms of minimally invasive surgery. In the first one, it’s more like laparoscopic surgery where, you know, the kind of surgery people have to have their gallbladders out. So, somewhere between one and three incisions are made and a scope, a telescope, is passed through one and instruments are passed through the others and all the structures that need to be divided are divided using these instruments. The specimen is then placed in a bag and taken out. The same thing when it is done with the use of a robot, of a surgical robot, it’s called robot-assisted surgery. You know, both of these have distinct advantages over what was traditionally done before. That’s open thoracic surgery where a big incision was made, and, you know, either a rib resected or cut and the ribs are spread and go in because patients having minimally invasive surgery, we are able to get them through the surgery even if they have marginal lung function, and they generally tend to recover better with fewer complications.
Bill: That’s amazing, and the new technology is just wonderful. Thanks for sharing that with us Dr. Yendamuri. So, this is the “What to Expect” series. So, for someone preparing for surgery, after surgery, etcetera, what should someone expect in those instances?
Dr. Yendamuri: Right. So, typically, once the patient is deemed a candidate for surgery, we teach them some breathing exercises to give them what we call an incentive spirometry. Essentially, it’s a little device which helps you get some breathing exercises. They usually come to the hospital on the morning of surgery. Gone are the days when people were admitted before. Typically, they show up on the day of surgery, after of course the anesthesiologist has seen them well before, and you know, we’ve dotted all our I’s and crossed our T’s before the patient shows up. The surgery usually takes between three and four hours, and when we are able to accomplish this minimally invasively, which we are able to do 95% of the time, the patient typically doesn’t even go to the ICU. They go to a monitored floor. They stay in the hospital roughly three days and then discharged home. The amazing thing about minimally invasive surgery is most people after this kind of surgery can go home directly. In the past, we would have to send a lot of our patients to a rehab facility or a nursing facility to recoup before they can go home, but minimally invasive surgery has really changed that paradigm, and at home, it takes them anywhere from two to four weeks to sort of feeling completely back to normal. But at the time of discharge, most patients are able to take care of themselves, and need, you know, only minimal support –
Bill: That’s –
Dr. Yendamuri: – from their system.
Bill: That’s amazing, absolutely amazing and good to here. And Roswell Park Cancer Institute has been recognized as a US top performing center in the area of lung cancer surgery. What does that exactly mean, Dr. Yendamuri, to a regular patient? Explain that to us.
Dr. Yendamuri: Right. So, the criteria for top-performing hospitals is made based on a number of things. One is it’s based on infrastructure – it depends on what kind of technology we have; what kind of ICU support we have; how our nurses are, and so on and so forth. The second component is actual performance in terms of how many cases we do, you know, what our outcomes are. You know, what the chance of dying from surgery is, and also, how often they're able to actually get patients home instead of them needing, you know, additional support or rehab or so on, so forth. And one of the reasons we have done so well in any outcomes measure anywhere using different scales is that we tend to perform most of our surgeries, like I mentioned before, about 95% of our operations through minimally invasive means. I think that’s really helped our patients and helped us take better care of them.
Bill: Ummm hmmm. And what did you do to achieve this? What kind of steps did you take?
Dr. Yendamuri: So, this is a program that has been built over the last 15 years. You know, starting in about 2002, 2003, we started adopting minimally invasive techniques, and over time, we’ve amassed a great deal of experience doing even complex resections through small incisions. We have, for example, one of the largest facilities in the country for doing minimally invasive pneumonectomies. That is taking out the entire lung through a small incision. We’ve done other complex resections, such as taking out portions of chest wall when the tumor invades the chest wall, and we’ve managed to do that thoracoscopically. So, it’s accumulated experience by the team, not just the surgeons, but the anesthesiologists, nurses, ICU staff, everyone in handling patients with these complex conditions, with the minimum of surgical trauma that has enabled us to get to this level of expertise.
Bill: Well, congratulations again. It’s been a 15-year journey but definitely well worth it. Dr. Yendamuri, thank you again for your time today and talking to us about lung cancer surgery as part of the What to Expect Series. For more information, you can visit roswellpark.org. That's roswellpark.org. You're listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I'm Bill Klaproth. Thanks for listening.