Transcription:
Thoracic Surgery at UK HealthCare

Melanie Cole (Host): The cardiothoracic surgery program at UK Healthcare provides expert care for major lung and esophageal surgery and minimally invasive techniques including robotic surgery. My guest today is Dr. Jonathan Kiev, he is a thoracic surgeon with the University of Kentucky Healthcare. Welcome to the show Dr. Kiev. So, what types of conditions does a thoracic surgeon treat?

Dr. Jonathan Kiev, MD (Guest): Well most commonly Melanie, we see patients that have both lung cancer and esophageal cancer. They are picked up through chest x-ray or CAT scan or even an upper GI if a patient has some type of swallowing dysfunction. So, they will be referred typically either by a pulmonologist, their primary care physician or even a gastroenterologist. Those are the most common things we see, lung and esophageal cancer, but we also see many patients that have had lung screening done. Maybe they are one of those high-risk type individuals that have been a heavy smoker previously or lived in home with a lot of smoking and a CAT scan was recommended to make sure that they were screened for early detection of lung cancer. So, we will see a patient with lung nodules or lung masses or very commonly, also patients with fluid around their lung, a pleural effusion that needs to be drained or needs to be evaluated through minimally invasive techniques. So, there is a variety of entry ways to see us and basically, we take care of anything above the diaphragm and including foregut disease. In other words, patients that have hiatal hernias or any type of hernia where they are having some kind of reflux or GERD. We take care of those folks as well.

Melanie: So, you know we are seeing more things, such as lung cancer and there is CT screening for lung cancer and there is – now there are all kinds of new advancements and technologies and I mentioned in the intro Dr. Kiev, robotic surgery. So, tell us what you are doing with robotic surgery in terms of esophageal and lung surgeries. How are you using this technology for better outcomes?

Dr. Kiev: Well the robot offers us a new platform to deliver the same type of care in an even more minimally invasive approach. So, using a robot, we are able to see through 3-D much better anatomy and much better visualization allows us to operate even in a more meticulous fashion. So, patients are able to get out of the hospital much quicker with lower morbidity or complication rate. So, we use the robot for both lung, lung resections where we are taking out portions of the lung or esophagostomy where we are remove the esophagus and we also use the robot for mediastinal diseases, patients that have large lymph nodes or maybe a large thymus gland. Patients that have let’s say a condition called myasthenia. They are referred to us by neurologists and some of these folks have what’s called a thymoma, a small or large tumor of the thymus gland right behind the sternal or the breast bone and we are able to use the robot to significantly see and operate in a much cleaner plane than we were before. So, there is no longer do we have to split the sternum or split the ribs. We are able to use the robot to get in there and remove these types of tumors and these types of pathologies, so the patients get out of the hospital much quicker with much lower need for pain medicine.

Melanie: So, what would you like to tell people about some of these thoracic conditions including esophageal conditions and preventions so that maybe they don’t have to come see you?

Dr. Kiev: I think the biggest thing that we see especially in Kentucky is patients tend to eat very quickly and they tend to eat thick and rich foods and meats and I think the important thing is if you have any problem swallowing, if you have any pain or food is getting stuck or you feeling a sticking feeling when food goes down, you probably ought to see somebody both for an endoscopy where we actually put a lighted tube or lighted scope down the esophagus or to be evaluated for reflux disease. Because those two things hiatal hernia and esophageal cancer are very common and we want to see these folks early so that we can intervene early and that so long term they do well. So, in terms of the esophagus, if you are having any kind of problems swallowing, any kind of problem with food sticking or pain on swallowing, or if you have noticed a change in your diet as a result of your eating because you are not able to tolerate certain types of consistencies of food, then you probably ought to see us right away. So, we can start the workup and make sure that the esophagus and the stomach are normal and make sure there is no complications. In terms of lung, what we would like to see since we are still a big smoking population and since we know there is still 140-150 thousand deaths per year due to lung cancer, we would like to see more people get screened with a low dose CAT scan of their chest and most local hospitals now will perform the study at a very nominal charge, so that we can pick up the lesions and the nodules in the lungs that may be deemed suspicious down the road and we can intervene on these lesions much earlier than later. The unfortunate thing about lung cancer, 75% of these folks are already advanced stage by the time they are discovered. So, we don’t want to see people when they have symptoms, we want to see people before that and that means if you have had a long history of smoking or smoke exposure or you have worked around asbestos or radon, we would like to see you earlier so we can do the CAT scan and potentially thwart any long-term complications that these lesions or potential cancers may cause down the road. If that makes sense.

Melanie: It does and so tell us about your team. We hear the term cardiothoracic surgery and so it’s sort of a combined center. And tell us about your team at University of Kentucky Healthcare.

Dr. Kiev: At University of Kentucky we have experts in aortic disease, in coronary artery disease, we have expert heart surgeons. We have expert pulmonologists. We have expert interventional pulmonologists, guys that are lung doctors that specialize in just the airway and they can put small probes and tubes down the airway and biopsy things that normally in the past, were very hard to see. Now these guys in combination with the radiologists are able to see lesions at a much earlier size and actually intervene and biopsy these lesions and actually mark these lesions much earlier so that we can surgically remove these lesions or treat these lesions with radiation, whatever is appropriately needed at a much earlier phase. So, the cardiothoracic team here at UK comprises a wide vast combination of people from nurse practitioners and physician’s assistants to expert surgeons both in cardiac surgery and thoracic surgery. We have a big team of oncologists who specialize just in the lung, also specialize in the esophagus and then we have an elite world class radiation oncology team as well who can provide radiation therapy and SBRT and all the associated therapies that may be needed. So, through this multidisciplinary team, that is all encompassing under the cardiothoracic team; we are able to see patients the same day and begin the workup right away and get the patient on to healing.

Melanie: That’s such great information. So, finish it up for us Dr. and just let the listeners know what you would like them to know about thoracic issues whether it is esophageal cancer or lung cancer or any of these types of things that you might treat and what you want them to know about ways to prevent them and the best ways to live a healthy lifestyle.

Dr. Kiev: Absolutely, I totally agree with you Melanie. The lifestyle is number one. I recognize that a lot of folks smoke and I recognize that it is a tough habit to quit. It takes a lot of encouragement and it takes some ancillary services including sometimes patches, nicotine gum, lozenges, or even medication. But it takes the will and the desire to quit which would help most folks. We see that tobacco not only causes the vast majority of lung cancers but overall, it causes about half a million smoking related deaths every year. So, not only the lung but the esophagus, the upper airway, the head and neck. There’s a whole lot of other areas that smoking and tobacco directly impact. So, of anything that’s most important is number one to try and stop smoking or smoking cessation or nicotine cessation is critical. In light of that, if the cancer has already started, it would be important for us to make an early diagnosis so that early intervention can happen as well. So, a chest x-ray and a CAT scan and thoughtful evaluation by a physician or a nurse practitioner is the way to start; with a complete history and physical and then with imaging. And then once these things are picked up, we encourage folks to pick up the phone and find a healthcare team that will treat you in a multidisciplinary manner meaning that they have all the things you need under one roof and that scheduling isn’t a difficult thing and that a nurse navigator will walk you through every step of the process so that all questions will be answered. So, for both lung and esophagus, we like to intervene early and we like to have people see a variety of specialists so that all their questions are answered and all opportunities are given to them.

Melanie: Thank you so much, what great information Dr. Kiev. Thank you so much for being with us today. This is UK HealthCast with the University of Kentucky Healthcare. For more information, you can go to Ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I’m Melanie Cole. Thanks so much for listening.