Joey Wahler (Host): It's a game-changing treatment, so we're discussing robotic lung cancer surgery. Our guest is Dr. Gavin Henry. He's Medical Director of the Tate Cancer Center, also chair of Thoracic Surgery at University of Maryland, Baltimore Washington Medical Center.

This is the Live Greater Podcast series, information for a Healthier You from the University of Maryland Medical System. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Henry. Welcome.

Dr. Gavin Henry: Happy. Hi, how are you?

Host: Great. Yourself?

Dr. Gavin Henry: Great. Great.

Host: Excellent. So, we're off to a great start. We appreciate the time. First, Maryland, as you well know, ranks among the top states in the nation for lung cancer surgery as a first course of treatment. So, what does that say, do you think, about how lung cancer is being detected and treated here? And why is early detection so important in this instance?

Dr. Gavin Henry: Well, I think the state of Maryland has a lot of high quality care in regards to hospitals in there. And they put a big emphasis on lung cancer screening; and therefore, our early detection. I think this has also helped with the increased rate for our surgical patients and surgical treatments. And it's really been a game changer over the last few years in regards to the lung cancer screening.

Host: When we talk about early detection in this case, tell people why that's so crucial.

Dr. Gavin Henry: Well, first of all, for lung cancer, it is so important to pick it up very early. Stage I or stage II, the prognosis can be very, very good. So, early detection is very, very important. And so, this is where lung cancer screening comes in. Just like with the other type of cancers that we deal with, colon, breast, prostate, you want to screen early because the earlier you detect it, the prognosis is better, and you can get to surgery a lot sooner.

Host: So that being said, give people an idea, please, of what lung cancer screening involves, how often you should get it, et cetera.

Dr. Gavin Henry: Well, there is a protocol or there is a guideline. The typical patient is anywhere between the ages of 50 to 80-- and this is the guidelines, 50 to 80, smoked for more than 20 years, or we say 20-pack years. So if you take one pack, they multiply by 20. We call that 20 pack years. And that's the guideline for screening.

And typically, what we've seen in the past, the rate of screening was relatively low, not only in the state of Maryland, but throughout the country. If you go back around 2010, the screening rates were like around 3% or 4%, which is pretty abysmal. We got it now up to maybe about 16-20%, and that's still pretty low, but we are making progress. But low-dose screening CT scans are very, very simple. It only gives up about 20% of the normal radiation, of the normal scanning, so that's good. And literally, it only takes probably less than 10 to 15 minutes for the CT scan. And so, we've made significant progress in regards to the imaging studies over the last decade or so.

Host: Okay. So, some good news on that front there. And by the way, there have been other Live Greater podcasts previously that discuss screenings in more detail, for those joining us, that would like to check those out as well. Now, for those joining us that may not be familiar, what exactly, Doctor, is robotic surgery and how is it different from traditional surgery for lung cancer? We should point out first that no robots have not taken over the operating room. There are still experts like yourself that are human, whose hands are behind the whole thing, right?

Dr. Gavin Henry: Yes, that is correct. Traditional surgery is what we call open surgery or open thoracotomy. The incision may be anywhere between 10 to 12 inches in size. It's a pretty large incision. But for thoracic surgery, we've started doing more minimally invasive surgery. And robotic surgery is a type of minimally invasive surgery. And the advantages for us is that we are able to have smaller instruments. The magnification on the vision is a lot higher. We have a lot less blood loss, but it does use the robot. The robot is just a tool. It just helps us to get better vision and also better tools within the platform.

Host: And so, that being said, what are the benefits of this for patients?

Dr. Gavin Henry: For patients, over a period of time since I've been personally doing it, we've had decreased length of stay, we may cut about a half a day to a day off your length of stay in the hospital, decreased in blood loss, decrease in pain, are really the biggest ones that we've definitely seen over this period of time.

Host: Of course, as you well know, robotic surgery has now touched just about every branch of surgery, it seems. We hear a lot of those that perform it like yourself, talking about how much more precise it enables you to be when operating. Why is that so important in this case?

Dr. Gavin Henry: Well, from a thoracic surgery standpoint, in the chest, we are around some major blood vessels that attach to the heart. And that's very important for us to be precise and have precision around those blood vessels. Also too, when we have to do dissections and we take lymph nodes out, we want to be precise also in order to get those. And we also can do more intense surgeries or more complicated surgeries because of the precision of the robot, which otherwise, in other many invasive forms or even the open form will be a little more challenging for the surgeon. The robot allows us to have increased magnification. And also, the instruments give us more degrees of articulation of our wrist or fingers that we would not otherwise have.

Host: It's really pretty amazing, isn't it?

Dr. Gavin Henry: Yeah. It's amazing. It's made my job a little bit easier.

Host: I'm sure it has. So, how do you go about deciding whether a patient is a good candidate for robotic surgery and how much of a factor, for instance, is the particular cancer stage of a patient?

Dr. Gavin Henry: I think with most thoracic surgeons now, I think most people will try to see if they can do almost every patient, mainly invasive or robotic if they can. So when you come into my practice, we're going to try to do your robotic, unless otherwise, unless there's a reason we can't. And those reasons could be a variety of reasons. It could be location of tumor, size of tumor, if a patient's had prior surgeries in his chest. But for most part, I would say over 90% of our patients are done robotically. And there are multiple decision factors. But, usually, most of our patients, we plan on doing robotically.

Host: Gotcha. Great to know that. But how about patients diagnosed at a later stage? Can surgery still be an option for them in some cases?

Dr. Gavin Henry: Yeah. Even though most of our patients, we do receive our early stage. Some that are later stage, they obviously have a little bit more of a intense treatment. They may get chemotherapy, they may get immunotherapy or radiation or all three. And in a certain subset of patients, those patients still may be able to get to surgery and we still may also be able to do it robotically too, although there are smaller in regards to percentages. But yes, that it's still possible too.

Host: So in terms of the actual patient experience, what can people expect before as they prep during the procedure and after in terms of recovery?

Dr. Gavin Henry: Well, from a prep standpoint, most of patients, when they come into the office, it's more explaining their diagnosis. And then, of course, we'll go into details about the surgery and what that means and where the incisions will be on the chest. Most of the incisions about three to four incisions, about a third of an inch in size, and we work in between the ribs, roughly right under the shoulder blade. And so, we describe this to patients. Pre-op, most patients always want to know, what do I have to do to get ready for surgery?

The biggest thing is walking and being active. That also helps, because those are some of the things that we expect them to do afterwards. And of course, if those patients are smoking, we try to hopefully ask them to decrease their smoking or stop if they can. During surgery or pre-op while they're in the hospital, we see them again. And, actually, when they make it into the operating room, some patients really want to see the robot. They want to see what it looks like. And of course, everyone has different impressions. And they want to name it and so forth. So, they also kind of get involved in some of the robotic jokes that we have.

And then, post-op, it's just like any other minimally invasive surgery. It's pretty standard. Most patients will stay in the hospital anywhere between two to three days. And when they get home, we don't really have a lot of restrictions, just no heavy lifting, but they can be very active. They can do stairs, they can shower, they can go to the store, really within the first two weeks. And by two weeks out, most patients have already driven themselves to their post-op visit. And they're recovering pretty quickly.

Host: Well, that's certainly comforting news. I'm sure. Now, a couple of other things. Robotic surgery is really part of a team approach to lung cancer care, right? So, how would you say it compares with the other treatments? People are maybe more accustomed to hearing about radiation, chemotherapy, or even immunotherapy.

Dr. Gavin Henry: Here at Baltimore, Washington Medical Center, we have what we call tumor board, and we have different types of tumor boards. Depending upon the area for thoracic, which is the chest, we have a thoracic tumor board where you have the medical oncologist, radiation oncologist, the pulmonologist and, of course, the surgeon.

And so, collectively, we make a plan for their patient. Do they need to get biopsy? Do they need chemo? Do they need immunotherapy or radiation prior or do they just go straight to surgery? So everyone, pretty much is evaluated by the whole set of healthcare providers. And it is just very similar to the other service line. And we at that time can decide if this patient's going to be a robotic candidate. We can decide if the patient is going to end up needing a biopsy or needing chemotherapy before, or immunotherapy before. So, a lot of those decisions are made behind the scenes. Sometimes even before the patient has actually seen me. We have at least an idea or sometimes it could be after also they've been seen.

Host: And it sounds like that's really important here, right, Doctor? Because I would imagine sometimes one of the first things people will ask you as a patient, if you suggest the robotic approach, "Well, how do I know that I might not be better at going one of these other routes?" And you can tell them, "Well, we've already weighed in with those experts as well, and here's what they think too," right?

Dr. Gavin Henry: Yeah. And I think that's important. Today is for the patient to be informed of all their different choices, because surgery is not only the only choice. Of course, there's choices for other treatments, but to have the patient understand that it's been discussed. But even in those cases, if they like to have a consultation with the other service lines such as medical oncology, radiation oncology, or whoever it may be, to make sure that they have those consultants see them and also too that they're well-informed so they can understand the decision-making process. So, information is power, information is king for the patients. And so, for the most part, most patients understand. Once they're informed, for them, the decision ends up not being too much of an issue.

Host: Absolutely. And in summary here, Doc, you've done a great job of breaking down some of the details. Overall, what's your message for those joining us regarding how innovations in robotic surgery have really changed the lung cancer outlook for patients and families? What does it really all boil down to in terms of what it means for them?

Dr. Gavin Henry: Well, it's definitely not the grandfather's surgery, that's for sure. Most patients would say, "Oh, my grandfather or father had this big surgery, and they had a huge incision, and they stay in the hospital for two weeks." No, that's no longer the case. Now, we can get patients in and out two to three days, sometimes even one day overnight for a major lung resection.

And I think that's important for them to know that times have changed. Early detection has made a big difference in regards to the screening. Our ability to biopsy smaller nodules to make the diagnosis at earlier stage. And then, of course, to get you to the robotic lung resection, all those have changed significantly over the last decade or so. And this allows patients to get back to work, get back to their life a lot quicker than it ever has been before.

Host: You're reminding me with what you mentioned a moment ago saying this is not your grandfather's surgery. Years ago, there was that commercial, "This is not your grandfather's Oldsmobile." So, kind of the same thing, right?

Dr. Gavin Henry: Yeah. Yeah.

Host: Well, folks, we trust you are now more familiar with robotic lung cancer surgery. Dr. Henry, it sounds like really just amazing stuff as we touched on earlier. Keep up all your great work, and thanks so much again.

Dr. Gavin Henry: Thank you very much for having me.

Host: Absolutely. And you can listen to more podcasts just like this one at umms.org/podcast on YouTube or on your favorite podcast platform. Now, if you found this episode helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again.