Surgical teams are now performing a new innovative technique that could mean the difference between life and death for Madeleine Florio.
Madeleine opted for this ground-breaking procedure after watching her mother, father, and sister die of lung cancer.
"This is really like GPS. You don't have to waste time looking at the map," said Raphael Bueno, MD, Thoracic Surgeon at Brigham and Women's Hospital.
A real-time CAT scan done during the surgery makes this different than a traditional procedure. That accurate image allows Bueno to mark the location of the tumor with a wire. He then makes a small incision and a tiny camera finds the wire and finds the tumor.
Bueno says had he performed the traditional procedure he would have removed more of madeleine's lung to make sure all the cancer is removed. With the new procedure, he knows he got it all.
"I knew it would have been a longer recovery," Florio said.
Bueno said many patients are at risk for reoccurrence. So by preserving more of the lung the first time, it could help them later on in life.
He said the procedure is for patients with small lung nodules. Patients with large cancers will need a bigger operation.
BACKGROUND: Lung cancer is the number one cause of cancer deaths in the U.S., and this holds true for both women and men. A tumor is the biggest indication that a person may have cancer. Tumors may be benign (noncancerous) or malignant (cancerous). Lung cancer is known to spread throughout the organs of the body and is very hard to control. Lung cancer can spread to the brain, liver, bones, or adrenal glands.
SYMPTOMS: At times, symptoms do not arise until later stages. Most symptoms of lung cancer include:
Shortness of breath
Coughing up blood
NEW PROCEDURE: Now, doctors are taking CAT scans during surgery to remove cancerous parts of the lung. This procedure is beneficial because doctors are able to see an accurate image of the tumor so they can pinpoint exactly where to make the incision and remove the tumor. Traditional procedures require a lot of guessing and uncertainty, which often leads to the reoccurrence of the cancer. This new procedure provides patients with better lung function, faster recovery, and quicker delivery of therapy.
Similar techniques include:
Navigational bronchoscopy uses real-time electromagnetic guidance to improve navigation within the lung parenchyma and offers diagnostic benefits over standard flexible bronchoscopy. This technique is valuable in performing biopsies of peripheral lung lesions and mediastinal lymph nodes for the staging of lung cancer.
Endobronchial ultrasound (EBUS) enables visualization of the tissue beyond the bronchial wall, including lymph nodes and lesions outside of the bronchial airways. This technique also enables simultaneous diagnosis and lung cancer staging
Raphael Bueno, MD, Professor of Surgery at Harvard Medical School and the Associate Chief of Thoracic Surgery at the Brigham and Women's Hospital, talks about a new way researchers are pinpointing lung cancer.
Tell me first off about Madeleine. What did you discover?
Dr. Bueno: She is a woman who had a slowly growing small nodule in her lung. Because of her history, we were very concerned with the possibility of lung cancer. She had multiple nodules at different stages of growth. We wanted to get this one out, but leave enough lung should we need to go back in a few years to get another nodule because we were very concerned that she had lung cancer.
Did it end up being lung cancer?
Dr. Bueno: Yes, in fact, she had two of them right next to each other; that was a surprise, but they were very, very early. They were stage 1 and they were the type of cancer that you discover early that is barely forming so you can't even feel it with your finger, you just can tell what it is on the CAT scan and under the microscope.
What does the new procedure entail?
Dr. Bueno: The old procedure is called VATS, video-assisted thoracic surgery; it's a minimally invasive way to cut a piece of the lung to get it out, minimally invasive to make it less painful. We added the "I" in it, and we call it IVATS. It's image-guided video-assisted thoracic surgery, and it lets us mark the nodule in real time in the operating room. The reason is that with the old procedure we have to look at the CAT scan on the screen to find the spot in the lung. In the new procedure, we can mark the spot just before doing the surgery using the CAT scan in the operating room and then be precise on removing the exact area of the cancer without having to remove extra lung and without leaving anything behind. I compare it to driving and plotting your course with a map versus plugging it into a GPS. I have a GPS in my car, so I don't use the maps anymore.
What's the benefit to the patient?
Dr. Bueno: There are a couple of benefits to the patient. For small nodules, we can identify them; we can take the nodule and not too much additional lung so they have more lung left to breathe with. Many patients with early lung cancer, we can cure now. The problem is once they get one lung cancer, they are at risk down the line of having a second lung cancer, and if we take too much lung at the beginning, 5, 6 years later, we don't have enough lung to take out the second cancer. This helps solve that problem as well.
How did you come up with this process?
Dr. Bueno: Well, it occurred to me that after doing thousands of lung surgery using the VATS technique that it was often hard to find the small nodules and the technology existed to identify them, so I married the imaging technology live with the surgery technology and we tested it on animals. We trained the team on how to do it and then we got approval from the institution to do a research trial which we're still doing and that's what we have been doing and she has been the first patient and she has done great.
How do you think this helps quality of life for patients?
Dr. Bueno: I think it helps in a lot of ways that we haven't thought about before. I think by making it more exact, we are making the patient more comfortable that we get the cancer out. We are also making the patient better in the sense that we take less lung out. In addition, we make the operation happen much faster. We know where the nodule is, we put in the probe, we do the operation, and it only takes 20 minutes to do the operation now.
How long would it have been?
Dr. Bueno: Sometimes it only took 20 minutes when you could see or palpate the nodule. But sometimes when you couldn't see the nodule, you had to really work hard, hard to identify where the nodule was and that could take an hour sometimes. I believe this is really like GPS; you don't have to waste time looking at the map. You just press the button and presto you got it.
For more information, please contact:
Raphael Bueno, MD
Brigham and Women's Hospital