Minimally invasive lobectomy halts early-stage lung cancer
By Nancy DiFiore
At the age of 89, Pam Jahoda’s father was diagnosed with stage I lung cancer. Two years later, Jahoda herself received the same shocking news.
While a cancer diagnosis can be devastating, Jahoda had reason for hope. Her father had undergone a successful lobectomy — the surgical removal of a part of the lung that includes a tumor or other abnormality. She sought out Michael Liptay, MD, a thoracic and cardiac surgeon at Rush, who performed her father’s lobectomy in 2011 with a special technique that uses much smaller incisions.
“My father went home within three days after his lobectomy surgery, which is remarkable at the age of 89. Getting a cancer diagnosis can be frightening, but I had no doubt that I would be in good hands with Dr. Liptay,” says Jahoda, 66, who lives southwest of Chicago in suburban Westmont and works for a certification testing company.
More people die from lung cancer than any other cancer. In 2012 (the most recent year for which data is available), 210,828 people were diagnosed with lung cancer and 157,423 people died of it, according to the U.S. Centers for Disease Control and Prevention. Lung cancer is the leading cause of deaths among Hispanics in the U.S., according to a new report from the American Cancer Society.
The outlook for lung cancer patients improves greatly if, as was the case with the Jahodas, their cancer is diagnosed at stage I, meaning it hasn’t yet spread beyond the lungs. Jahoda’s father decided to get a checkup after coughing up a very small amount of blood, which is uncommon in early-stage lung cancer. Pam Jahoda’s lung cancer was found accidentally in 2014 when she received an X-ray for frozen shoulder.
“By the time lung cancer becomes symptomatic, the disease is often late-stage with spread to other organs and incurable. When caught early and the disease is localized, surgery can provide a cure in up to 80 to 90 percent of patients,” Liptay says.
A VATS difference
Most lobectomies in the U.S. each year are still performed through an incision that stretches from the chest around to the shoulder blade, with the surgeon spreading the ribs and working through the spaces between them. This results in a more pain during a longer recovery time. Liptay and his team, however, performed the Jahoda’s lobectomies using video-assisted thorascopic surgery, or VATS for short.
During a VATS procedure, the surgeon passes surgical instruments into the chest cavity through a few small incisions. They include a miniature camera that sends real-time images of the surgical site to a monitor in the operating room, guiding the surgeon’s use of the other instruments to perform the lobectomy.
Cardiovascular and thoracic surgeons at Rush employed VATS for 74 percent of the lobectomies it performed for stage I lung cancer in 2014. Liptay, chairman of Rush’s Department of Cardiovascular-Thoracic Surgery, has used minimally invasive techniques to treat early-stage lung cancer in more than 3,000 cases over the last 17 years.
“His approach to his patients is very warm and caring, and he shows his patients a lot of respect. His staff is outstanding. I was in and out of the hospital in three days, and I had very little pain afterwards,” says Jahoda, who underwent her lobectomy in 2014. “Both my father and I had no limitations after the surgery, and we did not need radiation or chemotherapy. What more could I ask for?”
Jahoda currently has no sign of cancer. Her father lived three years after the lobectomy before passing away from kidney failure unrelated to his lung cancer.
Rush receives highest rating for lobectomy
Recently, the Society of Thoracic Surgeons has recognized this expertise by designating Rush’s Department of Cardiovascular and Thoracic Surgery a three-star program for lobectomy. It is the second consecutive year the program has received the society’s highest rating, which only is bestowed on the top 5 percent of thoracic surgery programs in the United States.
The rating is based on outcomes data the Society of Thoracic Surgeons received from Rush for the period from January 2012 through December 2014. The designation reflects the following outcomes of nearly 330 lobectomies that the department’s members performed over the reporting period:
- A 0.3 percent mortality rate 30 days mortality after lobectomy
- An average hospital length of stay of 4.2 days after lobectomy
- An absence of major complications, such as pneumonia or an unexpected need to return to the operating room, in 93.3 percent of patients
These results are significantly better than national averages for these outcomes.
This success reflects the program's expertise in VATS, which usually reduces pain and recovery times compared to open chest surgery, according to Liptay.
“Because this technique is less invasive from a surgical standpoint, these patients typically are released on the second day after surgery, rather than after a week, and they typically recover in three weeks rather than four to six weeks. It’s a dramatic difference,” Liptay says.
Less than a quarter of lobectomies that are performed around the country could have been done using minimally invasive techniques. Those performed are most often done the invasive way, by moving the ribs and with a larger incision.
“Because of the learning curve involved with training surgeons in these new approaches, it may take some time before the safe use of the minimally invasive technique is more common throughout the country. Our surgical residents in training will be helpful in bringing this technique to other areas,” Liptay says.