Clinical Briefing: Parenchyma-Sparing
Resections for Lung Cancer
July / August 2005
Due
to the aggressive use of bronchial sleeve and pulmonary arterial
sleeve lobectomy, when appropriate, the pneumonectomy rate
at Penn is less than half the rate at other hospitals in the
region. These procedures enable patients to avoid having their
entire lung removed, and thus decrease post-operative risks.
Penn surgeons are also among the few thoracic surgeons in
the country with expertise in performing pulmonary segmentectomy
when appropriate. Video-Assisted Thoracoscopic Surgical wedge
resections may be appropriate to treat small bronchoalveolar
tumors, which almost never metastasize to lymph nodes.
"The above approaches allow us to resect tumors in patients
with severe emphysema, who might otherwise be considered inoperable.
In addition, they enable us to reduce our complication rate
dramatically and allow our patients to enjoy shorter lengths
of stays following resections, the lowest in Pennsylvania,"
Joseph
B. Shrager, MD.
Case Study
 Mrs. R is a 60 year-old woman with moderately severe emphysema
(FEV1 50% of predicted) and a centrally-placed right upper
lobe lung cancer involving the right upper lobe bronchial
take-off.
She was told by a surgeon at an outlying hospital that she
was not a candidate for surgery since esection would require
a pneumonectomy and that she would likely not survive that
operation because of her reduced pulmonary function. She was
told that chemoradiation will likely only extend her life
and that her chances of cure are less than 10%. A family member
who had undergone successful lung surgery at HUP suggested
that she be seen here.
One of our surgeons agreed that she could not tolerate a
pneumonectomy, but he felt that the tumor could be removed
with excellent chance of cure by a sleeve right upper lobectomy,
sparing the right middle and lower lobes. Further, he felt
that because her right upper lobe was the area most severely
involved by emphysema, she might actually benefit from an
improvement in her dyspnea following the resection due to
a “volume reduction” effect.
Mrs. R. underwent sleeve right upper lobectomy in 2000 and
remains free of disease to date. Her pulmonary function has,
in fact, improved following the surgery, as has her quality
of life.
Our Areas of Expertise
The University of Pennsylvania Health System is one of
the busiest thoracic surgery programs in the country, performing
more than 1,200 operations each year. U.S. News & World
Report ranked the Hospital of the University of Pennsylvania
the highest in the region for the treatment of respiratory
disorders.
Our areas of expertise include:
- Sleeve resection as an alternative to pneumonectomy
- Transcervical thymectomy
- Video thoracoscopic lobectomy
- Lung volume reduction surgery
- Tracheal surgery
- Esophageal resection
Current Clinical Trials at Penn
- Tumor vaccines
- Mesothelioma
- Metastic pleural malignancies
- Non-small cell lung cancer accompanied by pleural dissemination
- Minimally invasive surgery with novel radiation delivery
- Adjuvant chemotherapies for lung cancer
- Methods to reduce post-op air leaks
- Cancer resections in severe emphysema
Our Team of Faculty
Our board-certified thoracic surgeons below are dedicated
exclusively to performing non-cardiac, thoracic surgery and
therefore perform more of these procedures than general or
cardiac surgeons throughout the region, who only occasionally
perform such procedures.
Several members of our staff serve on the editorial boards
of The Annals of Thoracic Surgery and the Journal of Thoracic
and Cardiovascular Surgery and are recognized in Best Doctors
in America®.
Larry
R. Kaiser, MD
Chair of Department of Surgery
University of Pennsylvania Health System
Chair of Surgery, Hospital of the University of Pennsylvania
Joseph
S. Friedberg, MD
Chief, General Thoracic Surgery
Penn Presbyterian Medical Center
John
C. Kucharczuk, MD
Thoracic Surgeon, Hospital of the University of Pennsylvania
Taine
T.V. Pechet, MD
Vice Chief, Surgery
Penn Presbyterian Medical Center
Access
Patient appointments are scheduled within one week as follows:
Monday, Thursday and Friday -
Hospital of the University of Pennsylvania
Silverstein Pavilion, 4th Floor
3400 Spruce Street, Philadelphia
Tuesday and Friday -
Penn Presbyterian Medical Center
Wright-Saunders Building, 2nd Floor
39th and Market streets, Philadelphia
To refer a patient and/or consult with a doctor:
Please contact your UPHS physician liaison with any concerns
or problems you may experience when referring your patient.
Locations
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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