Surgical Oncology/Thoracic Oncology

The divisions of general and thoracic surgery offer diagnosis and treatment for the entire range of solid tumors affecting the neck, breast, thorax, abdominal viscera, soft tissues and skin. Approximately 350 patients with malignancies of these sites are seen annually. Surgery plays a key role in the diagnosis, cure and palliation of these cancers. the majority of patients referred to the department of Surgery have primary disease and have surgical tumor removal planned as the sole method of treatment, or as part of a planned multi-modality approach to therapy. The surgeons work very closely with specialists from the division of medical Oncology and the Department of Radiation Oncology to provide the most advanced multi-modality care available.

Surgical Staging

With careful surgical staging, the most appropriate therapy, or combinations of therapies, can be designed for each patient and appropriate assignment can be made to a clinical protocol. Both surgical and non-surgical methods are used to provide staging information. Endoscopic ultrasound is used for esophageal, pancreatic and rectal tumors, in collaboration with the Division of Gastroenterology. Laparoscopic and thorascopic staging have been incorporated into the management of esophageal, pulmonary and pancreatic tumors, to supplement mediastinoscopy and more traditional methods of surgical staging. These modalities offer a unique opportunity to improve patient selection for optimal pre- and post-operative treatment strategies.

Conservative Resection and Minimally Invasive Techniques

Over the last decade or more, experience on a worldwide basis has shown that limited surgery of cancers of selected sites, combined with radiation therapy, is as effective as more radical surgery and provides improved quality of life. These include carcinomas of the breast, extremity sarcomas, and early cancers of the rectum. When possible, patients are offered conservative resection for cancers of these sites and are guided through the necessary rehabilitation to ensure adequate post-operative functioning.

Surgeons at the Health Science Center are experienced not only in conservative resection techniques but also in minimally invasive techniques including laparoscopy and thoracoscopy. In addition, an emphasis is placed on prompt mobilization following surgery and rapid progression towards early hospital discharge. Effective pain control, including the use of epidural analgesia, facilitates this.

Advanced Disease

Patients are offered surgical resection of advanced and locally recurrent tumors, as well as those metastatic lesions which are known to benefit from resection (e.g. limited hepatic metastases of colorectal cancer, isolated metastases of melanoma and sarcoma). When appropriate, these patients are entered into studies of post-resectional adjuvant therapy. Palliative therapy (laser, bypass, stent placement) are available for advanced esophageal and lung cancers, sometimes in conjunction with internal radiation therapy.

High Risk Patients

Many patients with cancer have other significant medical illnesses, such as severe heart and lung disease, and many of the cancers require special surgical techniques because of their location. We provide extensive preoperative work ups, if necessary, and postoperative intensive care services so that even patients with markedly compromised respiratory function, for instance, can undergo surgery for lung cancer. Our state-ofthe-art intensive care units are able to provide the early post-operative care necessary to assure success in such patients.

Special Programs: Thoracic Oncology

The Division of Thoracic Surgery has a special interest in thoracic oncology providing care to patients with all stages of lung cancer, esophageal cancer, thymoma, mesothelioma and metastases to the chest. We work in close cooperation with the Divisions of Pulmonary Medicine and Cardiology, as well as the oncologic specialties to provide accurate preoperative assessment of a patient's risk, including cardiopulmonary exercise testing to assess a patient's tolerance for surgery.
Research surgeons in the Department of Surgery actively participate in the clinical studies of Cancer and Leukemia Group B (CALGB), a nationwide cancer study group. Our surgeons play a pivotal role in the design and conduct of multi-institutional studies designed to find the answers to many pressing questions in the care of patients with malignant disease. We have one of the highest accrual rates to surgical studies among the 30 major medical centers participating in CALGB. We also offer cancer prevention studies, such as Tamoxifen prophylaxis for breast cancer, Cisretinoic acid for lung cancer, and aspirin for colorectal cancer.

Laboratory research involves early detection of malignant disease and includes projects designed to improve our ability to predict breast and colon cancer risk.

Leslie Kohman, MD, Professor of Surgery
Seema A. Khan, MD, Asst. Professor of Surgery