Clinician-to-Clinician Update Clinician-to-Clinician Update

Minimally Invasive Thoracic Cancer Surgery Reduces Complications

May 2015

Thoracic cancers include cancers of the esophagus, trachea, lung, mediastinum, thymus, and mesothelioma. For patients with thoracic cancers in which surgery is indicated, minimally invasive procedures—including thoracoscopy, video-assisted thoracoscopic surgery (VATS), and minimally invasive esophagectomy—can be an excellent option. Research comparing outcomes of thoracic cancer patients undergoing minimally invasive surgery to those undergoing open surgery indicates that minimally invasive techniques are associated with improvements in morbidity rates, lengths of hospital stay, and postsurgical pain. 1

LungCancerScreening ThoracicCancer chart

For lung cancer resection, studies support the use of a minimally invasive approach over an open surgical approach. In a large, systematic review of 39 studies comparing standard lobectomy with VATS, researchers found that VATS was associated with shorter chest-tube duration, shorter length of hospital stay, and improved survival at 4 years after resection. 2 A more recent, large retrospective study comparing outcomes of 7,137 open-surgery patients to that of 4,394 patients receiving VATS in clinical stage I primary lung cancer resections found that patients undergoing VATS experienced significantly fewer pulmonary complications and atrial arrhythmias and were less likely to undergo transfusion.

Faster postsurgical recovery and return to baseline quality of life have also been shown to allow for a quicker time to administration of adjuvant chemotherapy (about 2 weeks faster) for those patients who require it. 3 An improved rate of survival and fewer pulmonary infections have also been reported for minimally invasive esophagectomy for esophageal cancer.4, 5

Thoracic surgeons at University of Minnesota Medical Center perform approximately 500 thoracic cancer procedures annually. About 90% of these are performed using minimally invasive techniques, without compromising oncologic principles (See Figure). The thoracic cancer team partners seamlessly with other University of Minnesota Health specialties, including medical oncology, radiation oncology, gastroenterology, pathology, pulmonary medicine, and radiology. This multidisciplinary approach, coupled with surgical expertise, ensures optimal treatment for patients with thoracic cancer.

References

1. Cheng AM, Wood DE. Minimally invasive resection of early lung cancers. Oncology (Williston Park). 2015;29:3.

2. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008;86:2008-2016.

3. Teh E, Abah U, Church D, et al. What is the extent of the advantage of video-assisted thoracoscopic surgical resection over thoracotomy in terms of delivery of adjuvant chemotherapy following non-small-cell lung cancer resection? Interact Cardiovasc Thorac Surg. 2014;19:656-660.

4. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887-1892.

5. Palazzo F, Rosato EL, Chaudhary A, et al. Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction. J Am Coll Surg. 2015;220:672-679.

When to refer

We value our relationship with you, your patients, and your office staff. We work hard to keep you informed of your patients’ care by providing detailed reports, from diagnosis to treatment and follow-up. Our goal is to provide you with prompt service and communication for the patients that you refer to us.

To schedule a cancer consultation, referral or appointment: 855-486-7226 

To schedule a physician meeting or visit: 612-867-3411 

Collaborative Care 

Many patients live long distances from University of Minnesota Medical Center. To minimize travel difficulties and lost time from school or work for our patients, we are committed to partnering with the patient’s referring provider and other local providers. Some patients can be initially discussed over the phone in collaboration with the referring provider. We aim to expedite the process so that, in one trip to the Twin Cities, patients can be assessed and also complete surgery, if required. In many cases, care after discharge can also be provided locally.

Physician Outreach Program

The Cancer Care Outreach Program is designed to provide education and facilitate knowledge sharing between our team and the medical community. To schedule a physician meeting or to visit our facility, contact Melinda Arvold, Oncology Outreach Manager. Phone: 612-867-3411; email: marvold1@fairview.org. 

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