Archive for the ‘Thoracic Surgery’ Category

The Power of Preservation: Minimally Invasive Lung Cancer Treatment at South Nassau Communities Hospital

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Posted 03 Jan 2012 — by James Street
Category Lung Cancer, Osteosarcoma surgery, Surgery, Surgery, Thoracic Surgery

A decade ago, a lung cancer diagnosis left both patients and physicians with few options. Today, while surgery remains the gold standard, the approach to this treatment has changed. Thoracic surgeons at South Nassau Communities Hospital are forging innovative surgical ground and safeguarding patients’ lungs.

According to the American Cancer Society, 221,130 new cases of lung cancer will be diagnosed in 2011. Almost 17,000 cases of esophageal cancer will be diagnosed, and, though the incidence rate is extremely low, patients with these types of cancers can develop tumors within and around the heart. Before 2004, Long Island residents with disease of the chest cavity made the long trek to Manhattan for consultations, treatments and follow-up care.

With the arrival of Shahriyour Andaz, M.D., FACS, FRCS, Director of Thoracic Oncology at South Nassau Communities Hospital and associate professor in the Department of Surgery at Hofstra University, two principles of thoracic care on Long Island have shifted significantly. Patients now have an alternative to Manhattan medicine, and with the investment in advanced technologies at South Nassau Communities Hospital, they also have an alternative to traditional open chest surgery.

“In the past, surgeons would make a large incision to cut the ribs and access the chest. That was a painful operation, so we’ve moved away from major incisions to doing smaller and smaller cuts,” says Dr. Andaz. “Now, 80% to 90% of all the cancer we take out is done through small, minimally invasive incisions.”

A Renaissance of Surgical Technique

The robotic da Vinci Surgical System offers Dr. Andaz and his colleagues in the thoracic oncology program the visualization and maneuverability necessary to promote minimally invasive approaches to technically demanding procedures. The three-dimensional views and flexibility of robotic hands, which are carefully controlled by the surgeon, facilitate the delicate dissection of blood vessels and the resection of the lungs’ lobes through centimeter-long incisions.

In the case of a video-assisted thoracoscopy, which allows the surgeon to evaluate the chest cavity for lung cancer or remove a tissue sample for further analysis, the da Vinci Surgical System has supplanted the need for an open chest thoracotomy. Dr. Andaz makes two or three small incisions between the ribs, and the lung is deflated to allow for a greater space between the lung and chest wall. That vantage point provides access to the lung for an endoscope, which Dr. Andaz uses to view and sample any potentially malignant tumor on the lung. The sample is then sent to the laboratory for pathological testing.

While the da Vinci Surgical System is utilized for general, gynecologic, kidney, prostate and urologic procedures, the technology allowed Dr. Andaz to become the first health care provider on Long Island to perform a robotic thymectomy and robotic bilobectomy in 2010 and 2011, respectively.

Operating Across the Aisle

“Most surgeons will not do a bilobectomy for central tumors — the type of tumor that straddles the airway and involves blood vessels stuck to the tumor,” says Dr. Andaz. “The da Vinci can help with the tedious process of dissecting those blood vessels.”

The complexity of a bilobectomy is grounded in the need to remove both the lower and middle lobes of the lung — leaving only the upper lobe — to ensure that wide enough margins are created and no cancer cells are left behind. In addition, the complex network of blood vessels stretching over the fissures in the lungs poses a challenge in cleanly resecting the necessary portions of the lung.

To begin, the attending anesthesiologist puts the patient under and slowly deflates one lung. Dr. Andaz then makes four 2-centimeter-long incisions in the chest wall and guides the da Vinci Surgical System’s robotic arms into the chest through the incisions, allowing him to concentrate on excising the lower lobe. The precise instrumentation divides the blood vessels and pulmonary vein from the lung tissue without disrupting the blood flow to the heart.

Next, Dr. Andaz exposes the fissure between the lower and middle lobes to allow for visualization of the pulmonary artery. With the three-dimensional da Vinci Surgical System camera, he is able to safely encircle and divide the branches leading to the lower lobe. After removing the lower lobe tissue, 
Dr. Andaz begins dissecting the pulmonary artery branches to the middle lobe. That separation allows him to dissect and divide the bronchus to the middle and lower lobes.

Dr. Andaz explains that the ability to remove both the lower and middle lobes of the lung can often depend on how much reserve a patient has in his or her lungs. The resection of one lobe diminishes lung function by 10% to 15%; the loss of two lobes results in a 20% to 25% reduction in total capacity; and the removal of all three lobes — the entire right lung — equals a 40% to 50% loss of the combined lung capacity. All surgical candidates undergo pulmonary function testing before being cleared for robotic surgery.

After the final tissue resection, Dr. Andaz retracts the da Vinci Surgical System’s arms and closes the incisions while the anesthesiologist carefully re-inflates the lung. Patients typically remain in the inpatient unit at South Nassau Communities Hospital for four to five days.

Tackling the Thymus Gland

Just as the da Vinci Surgical System has allowed Dr. Andaz and his colleagues to move away from the open chest thoracotomy, the technology has opened up new avenues for removing the thymus gland. The traditional procedure involved splitting the sternum with a major incision to access the chest cavity. Dr. Andaz can perform a robotic thymectomy instead, which approaches the organ — located in a tight space between the heart and the breastbone — through small incisions placed on the side of the patient.

“Usually, as a person ages, the thymus gland — like the tonsils — becomes smaller and almost disappears,” says Dr. Andaz. “For some people, however, the thymus gland continues to grow and enlarge and can lead to myasthenia gravis, an autoimmune disease that allows small proteins to cling to muscle receptors and leads to a neuromuscular disorder.”

Myasthenia gravis can present through symptoms centering on fatigue, including drooping eyes, difficulty breathing, chewing and swallowing, and weakness in the arms and legs. As Dr. Andaz explains, removing the thymus gland in patients with the condition can provide significant relief for their symptoms.

For the robotic procedure, 
Dr. Andaz makes three 2-centimeter incisions at the side of the chest for lateral access. Seated at the da Vinci Surgical System console, Dr. Andaz manipulates the robotic arms to find the thymus gland behind the breastbone. He then completes the delicate separation of the gland from the adjacent fat, pericardium and the innominate vein.

After resecting the thymus gland, Dr. Andaz closes the incisions, and the anesthesiologist re-inflates the lung. Patients typically spend one to two days in the hospital and are back to work in one or two weeks.

Targeting the Right Site

For lung cancer patients whose poor lung reserves eliminate them from the surgical candidate pool, radiation has traditionally been the next treatment option. The choice is often made in an attempt to conserve what little function the lungs have. However, standard radiation often poses a significant threat not only to the tumor, but also to the surrounding healthy tissue.

“The problem with standard radiation is that the treatment can essentially cook the entire lung. The radiation can damage the surrounding lung tissue, which is difficult for someone who has poor lung reserve to begin with,” says Dr. Andaz. “The Novalis Tx radiosurgery technology uses advanced computerized techniques to focus an intense radiation beam on the tumor site only to preserve the rest of the lung.”

The radiosurgery platform offers a noninvasive, customizable treatment alternative to surgery. The system’s mechanical accuracy is within 0.5 millimeters of the tumor site during treatment, while the MV Portal Vision allows radiation oncologists to view the exact location of the tumor as the system targets it.

The Novalis Tx is also equipped with gating features to adapt the radiation to the patient’s natural respiration cycle. In addition, the system reduces the requisite number of treatments as compared to the standard radiation therapy. Patients undergo treatment once a week for only three to four weeks rather than six weeks.

The Communal Process

Every month, the specialists within the thoracic oncology program meet for a program-specific tumor board. The conference reviews patient cases one by one for insight from each physician, even those not directly involved in the treatment, which allows for a dynamic and multifaceted discourse. Medical oncologists, pathologists, pulmonologists, radiation oncologists, radiologists and surgeons are joined by primary care physicians to evaluate a patient from every possible perspective.

“These are very complicated decisions, and it requires lots of people to be involved in the decision-making process,” says Dr. Andaz. “I’m very open to the discussion of alternatives to the management of the case.”

In addition, staff with the thoracic oncology program participate in the weekly tumor board at South Nassau Communities Hospital and meet on a need-appropriate basis between the established conferences.

To learn more about thoracic oncology at South Nassau Communities Hospital, visit www.southnassau.org and click on “Surgical Services” and “da Vinci Robotic Surgery” under the “Services/Specialty Centers” tab.

 

A Measure of Change in Lung Cancer Detection

To maximize the rate of survival among women with breast cancer, the American Cancer Society recommends every woman receive a mammogram annually after age 40. To increase the survival rate among men and women diagnosed with colon cancer, the organization advises people older than 50 undergo a colonoscopy every 10 years. Now, lung cancer has a similar screening recommendation.

A 1991 initiative launched by a group of physicians from Cornell University Medical Center — investigating the impact of helical computed tomography (CT) imaging on the early detection of lung cancer — discovered that, when caught in Stage I, lung cancer isn’t as deadly.

“The traditional data has shown the overall survival rate is 15% at five years, meaning that 85% of patients will die,” says Shahriyour Andaz, M.D., FACS, FRCS, Director of Thoracic Oncology at South Nassau Communities Hospital and associate professor in the Department of Surgery at Hofstra University. “The participants in the Cornell study showed a survival rate far superior than any other data we have: 90% at 10 years. Even though lung cancer is three times as prevalent as breast cancer, there has been no test to detect early lung cancer — until this.”

In fact, the initiative has developed protocols to a) identify high-risk patients, b) distinguish between benign and malignant nodules detected by the CT scan, and c) determine when to biopsy or monitor the nodules, as well as timetables for when to follow up with patients. The International Early Lung Cancer Action Program (I-ELCAP) includes 48 institutions in nine countries, including South Nassau Communities Hospital, where Dr. Andaz pioneered the program.

Dr. Andaz recognized the significance of the I-ELCAP, and for the last three years, South Nassau Communities Hospital has contributed data to the program while offering free CT scans for high-risk patients in the community. The data is then sent to Mount Sinai Medical Center and incorporated into the I-ELCAP database. According to Dr. Andaz, of the 800 to 900 patients imaged at South Nassau Communities Hospital, 30 have been diagnosed with lung cancer, and 90% of the cases were detected within Stage I.

 

Purdue technology used in first fluorescence-guided ovarian cancer surgery

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Posted 19 Sep 2011 — by James Street
Category Osteosarcoma surgery, Ovarian, Physics and Engineering, Thoracic Surgery

IMAGE: This is a surgeon’s view of ovarian cancer cells with and without the tumor-targeted fluorescent imaging agent.

Click here for more information.

WEST LAFAYETTE, Ind. – The first fluorescence-guided surgery on an ovarian cancer patient was performed using a cancer cell “homing device” and imaging agent created by a Purdue University researcher.

The surgery was one of 10 performed as part of the first phase of a clinical trial to evaluate a new technology to aid surgeons in the removal of malignant tissue from ovarian cancer patients. The method illuminates cancer cells to help surgeons identify and remove smaller tumors that could otherwise be missed.

Philip Low, the Ralph C. Corely Distinguished Professor of Chemistry who invented the technology, said surgeons were able to see clusters of cancer cells as small as one-tenth of a millimeter, as opposed to the earlier average minimal cluster size of 3 millimeters in diameter based on current methods of visual and tactile detection.

“Ovarian cancer is notoriously difficult to see, and this technique allowed surgeons to spot a tumor 30 times smaller than the smallest they could detect using standard techniques,” Low said. “By dramatically improving the detection of the cancer – by literally lighting it up – cancer removal is dramatically improved.”

The technique attaches a fluorescent imaging agent to a modified form of the vitamin folic acid, which acts as a “homing device” to seek out and attach to ovarian cancer cells. Patients are injected with the combination two hours prior to surgery and a special camera system, called a multispectral fluorescence camera, then illuminates the cancer cells and displays their location on a flat-screen monitor next to the patient during surgery.

The surgeons involved in this study reported finding an average of 34 tumor deposits using this technique, compared with an average of seven tumor deposits using visual and tactile observations alone. A paper detailing the study was published online Sunday (Sept. 18) in Nature Medicine.

Gooitzen van Dam, a professor and surgeon at the University of Groningen in The Netherlands where the surgeries took place, said the imaging system fits in well with current surgical practice.

“This system is very easy to use and fits seamlessly in the way surgeons do open and laparoscopic surgery, which is the direction most surgeries are headed in the future,” said van Dam, who is a surgeon in the division of surgical oncology and Bio-Optical Imaging Center at the University of Groningen. “I think this technology will revolutionize surgical vision. I foresee it becoming a new standard in cancer surgery in a very short time.”

Research has shown that the less cancerous tissue that remains, the easier it is for chemotherapy or immunotherapy to work, Low said.

“With ovarian cancer it is clear that the more cancer you can remove, the better the prognosis for the patient,” he said. “This is why we chose to begin with ovarian cancer. It seemed like the best place to start to make a difference in people’s lives.”

By focusing on removal of malignant tissue as opposed to evaluating patient outcome, Low dramatically reduced the amount of time the clinical trial would take to complete.

“What we are really after is a better outcome for patients, but if we had instead designed the clinical trial to evaluate the impact of fluorescence-guided surgery on life expectancy, we would have had to follow patients for years and years,” he said. “By instead evaluating if we can identify and remove more malignant tissue with the aid of fluorescence imaging, we are able to quantify the impact of this novel approach within two hours after surgery. We hope this will allow the technology to be approved for general use in a much shorter time.”

Low and his team are now making arrangements to work with the Mayo Clinic for the next phase of clinical trials.

The technology is based on Low’s discovery that folic acid, or folate, can be used like a Trojan horse to sneak an imaging agent or drug into a cancer cell. Most ovarian cancer cells require large amounts of the vitamin to grow and divide, and special receptors on the cell’s surface grab the vitamin – and whatever is linked to it – and pull it inside. Not all cancer cells express the folate receptor, and a simple test is necessary to determine if a specific patient’s cancer expresses the receptor in large enough quantities for the technique to work, he said.

IMAGE: Philip Low is pictured here in the lab.

Click here for more information.

Ovarian cancer has one of the highest rates of folate receptor expression at about 85 percent. Approximately 80 percent of endometrial, lung and kidney cancers, and 50 percent of breast and colon cancers also express the receptor, he said.

Low also is investigating targeting molecules that could be used to carry attached imaging agents or drugs to forms of cancer that do not have folate receptors.

He next plans to develop a red fluorescent imaging agent that can be seen through the skin and deep into the body. The current agent uses a green dye that had already been through the approval process to be used in patients, but cannot easily be seen when present deep in tissue. Green light uses a relatively short wavelength that limits its ability to pass through the body, whereas the longer wavelengths of a red fluorescent dye can easily be seen through tissue.

“We want to be able to see deeper into the tissue, beyond the surface,” Low said. “Different cancers have tumors with different characteristics, and some branch and wind their way deeper into tissue. We will continue to evolve this technology and make improvements that help cancer patients.”

In addition to Low and van Dam, the paper’s authors include George Themelis, Athanasios Sarantopoulos and Vasilis Ntziachristos of the Institute for Biological and Medical Imaging at the Technical University of Munich in Germany; Lucia Crane, Niels Harlaar, Rick Pleijhuis, Wendy Kelder and Johannes de Jong of the division of surgical oncology of the BioOptical Imaging Center at the University of Groningen; Henriette Arts and Ate van der Zee of the division of gynaecological oncology at the University of Groningen; and Joost Bart of the Department of Pathology and Molecular Biology of the University Medical Center of Groningen.

Low is the chief science officer for Endocyte Inc., a Purdue Research Park-based company that develops receptor-targeted therapeutics for the treatment of cancer and autoimmune diseases. Endocyte holds the license to the folate receptor-targeting technology and is spinning this technology off into a new company called OnTarget.

Ntziachristos led the team at the Technical University of Munich that developed the camera system. A startup company named SurgOptix BV is working to commercialize the camera system.

###

The clinical trial was funded by Endocyte Inc. and the University Medical Center of Groningen.

Writer: Elizabeth K. Gardner, 765-494-2081, ekgardner@purdue.edu

Sources: Philip Low, 765-494-5273, plow@purdue.edu Gooitzen van Dam, 31-50-3612283, g.m.van.dam@chir.umcg.nl

Related website: Philip Low research page: http://www.chem.purdue.edu/low/

VIDEO CAPTION:

Fluorescence-guided surgery on an ovarian cancer patient is shown.

Video is available at http://www.youtube.com/watch?v=CcUFTLVonqs

IMAGE CAPTION:

A surgeon’s view of ovarian cancer cells with and without the tumor-targeted fluorescent imaging agent. (Image courtesy of Philip Low)

A publication-quality image is available at http://news.uns.purdue.edu/images/2011/low-fluorescent.jpg

PHOTO:

Philip Low – http://news.uns.purdue.edu/images/2011/low-labshot.jpg

Abstract on the research in this release is available at: http://www.purdue.edu/newsroom/research/2011/110918LowSurgery.html

Combination radiofrequency thermal ablation and adjuvant IV liposomal doxorubicin increases tissue coagulation and intratumoural drug accumulation

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Posted 04 Sep 2011 — by James Street
Category Local Recurrence, Lung Metastases, Radio Frequency RF, Thoracic Surgery
2004, Vol. 20, No. 7 , Pages 781-802 (doi:10.1080/02656730410001711655)

M. Ahmed and S. N. Goldberg*

1Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
Correspondence: S. N., Goldberg Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA sgoldber@caregroup.harvard.edu

 

There has been marked interest in minimally-invasive, image-guided radiofrequency (RF) tumour ablation (i.e. coagulating tumour using short duration heating (<15 min) by directly applying temperatures >50°C via needle electrodes) to treat focal liver, renal, breast, bone and lung tumours. In spite of advances in RF technology and improved understanding of tumour biophysiology that now enable experimental treatment of tumours up to 5 cm, investigators have been unable to achieve complete ablation in many cases, particularly at the tumour margins and adjacent to blood vessels. One strategy for overcoming these limitations has been to take advantage of complementary interactions between RF thermal ablation and chemotherapy, particularly liposomal doxorubicin preparations, to attempt more complete tumour destruction. This paper will review published laboratory investigations demonstrating that this combined treatment paradigm has the unique potential both to potentiate preferential delivery of cytotoxic agents in liposome vehicles and to maximize the completeness of ablation of a treated tumour. New confirmatory data describing increased tumour destruction with RF ablation combined with different liposome preparations, documenting increased lipid peroxidation and expanding on previously published tumour growth studies is presented. Additionally, early clinical data including a randomized, pilot clinical study on 10 patients with primary and metastatic liver tumours, in which a non-optimized combination of RF ablation and IV liposomal doxorubicin (Doxil) increased the volume of tumour destruction 25–30% compared to RF alone, will also be described in detail.

Radio-Guided Surgery A Safe And Simple Way To Remove Potentially Cancerous Nodules In The Lung

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Posted 03 Mar 2011 — by James Street
Category Lung Metastases, Metastases, Osteosarcoma Treatment Centers, Surgery, Thoracic Surgery

28 Feb 2011

Using tiny spheres of radioactive liquid to guide surgeons as they remove potentially cancerous material in the lungs is safe and more effective than other techniques, Italian researchers report at the European Multidisciplinary Conference in Thoracic Oncology (EMCTO), 24-26 February 2011, Lugano, Switzerland.

Dr Luca Bertolaccini, Dr Alberto Terzi and colleagues from Santa Croce e Carle Hospital in Cuneo, Italy, studied a technique known as radio-guided surgery in 19 patients. Each of the patients had been found to have ‘single pulmonary nodules’ in their lungs.

Single pulmonary nodules are solitary abnormalities in the lungs that are smaller than 3 cm in diameter. Improvements in scanning techniques such as computed tomography mean that these very small nodules are becoming more commonly found.

If such nodules are found to be malignant, then surgical treatment to remove them should be undertaken immediately, Dr Bertolaccini said. “The problem is that such lesions are usually peripheral, making bronchoscopic approaches to diagnosis unsuccessful, while the accuracy of CT-guided biopsy is hindered by the small diameter and by the patient’s respiratory movements during the exam.”

“Video-assisted thoracoscopic surgery (VATS) is nowadays the procedure of choice if we want to surgically biopsy and remove peripheral lung nodules. However, the use of VATS is limited by the difficulty in localizing small, deep, or non-solid lung nodules where direct finger palpation may not be possible during surgery.”

Using radio-guided surgery appears to overcome these problems, the researchers found. First they inserted a needle into the lung to reach the lesion or the lung tissue surrounding it. A CT scan carried out while the needle was in place confirmed its exact position.

Next, they injected a solution of 0.3 ml of microspheres of human albumin serum labeled with Technetium (99mTc), an element that is often used for medical tests. After injection, they used another CT scan and a technique called gamma scintigraphy –which visualizes the gamma radiation being emitted by the radioactive isotope– to confirm precise staining of the nodule.

During surgery to remove the nodule, the researchers used a gamma detector probe to ensure they had removed all the radio-labeled tissue.

The researchers found that the technique was able to localize nodules in all 19 patients. On average it took 6 minutes to detect the nodule with the gamma probe.

Further analysis of the tissue that had been removed showed that it was a primary lung cancer in 8 cases, and a secondary lesion in 4 cases. The remaining 7 patients were found to have benign nodules. There were no complications during or after surgery.

This study shows that radio-guided surgery is a safe and simple technique for localizing single pulmonary nodules, Dr Terzi said. “Radio-guided thoracoscopy seems to be an effective procedure with fewer complications and failures than other techniques.”

Commenting on the study, Dr Eric Lim, Consultant Thoracic Surgeon, Royal Brompton Hospital and Senior Lecturer, National Heart and Lung Institute, Imperial College, London, who was not involved in the study, said: “Dr Bertolaccini reports an innovative method to localize nodules that can be difficult for the surgeon to identify during routine surgery.”

“This technology supports the current practice of video-assisted thoracoscopic lung resection as surgeons continuously strive to reduce incision size, pain and length of stay to increase the acceptability of surgery for lung cancer,” said Dr Lim.

Source:
Vanessa Pavinato
European Society for Medical Oncology

Article URL: http://www.medicalnewstoday.com/articles/217657.php

Main News Category: Cancer / Oncology

Also Appears In:  Lung Cancer,  Radiology / Nuclear Medicine,

Lung Cancer Biopsies and Radio-Guided surgery more effective than other techniques

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Posted 28 Feb 2011 — by James Street
Category Lung Metastases, Metastases, Surgery, Thoracic Surgery

Italian researchers told the conference that they have discovered a better way to remove potentially cancerous material from lungs.

Dr Luca Bertolaccini, Dr Alberto Terzi and colleagues from Santa Croce e Carle Hospital in Cuneo, Italy said that radio-guided surgery was safe and “more effective” than other techniques.

Their technique has been used to remove single pulmonary nodules in lungs. The new imaging technologies are spotting these nodules more frequently. If these single nodules are found to be cancerous, surgeons need to remove them quickly.

The current method to biopsy these nodules is Video-assisted thoracoscopic surgery (VATS). It is difficult to use this technique for localized small, deep, or non-solid lung nodules.

“The problem is that such lesions are usually peripheral, making bronchoscopic approaches to diagnosis unsuccessful, while the accuracy of CT-guided biopsy is hindered by the small diameter and by the patient’s respiratory movements during the exam,” Bertolaccini said.

By Jason Chang
Health Reporter

Image: Lung small cell carcinoma by core needle biopsy – Wikimedia Commons

Effects of morphine, fentanyl and tramadol on human immune response

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Posted 28 Jan 2011 — by James Street
Category Immune System, Surgery, Thoracic Surgery
1. J Huazhong Univ Sci Technolog Med Sci. 2006;26(4):478-81.

Effects of morphine, fentanyl and tramadol on human immune response.

Liu Z, Gao F, Tian Y.Department of Anesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China.

Abstract

Morphine has been reported to suppress human immune response. We aimed to observe the effects of morphine, fentanyl and tramadol on NF-kappa B and IL-2 from both laboratory and clinical perspective. Jurkat cells were incubated with ten times clinically relevant concentrations of morphine, fentanyl and tramadol before being stimulated with PMA. NF-kappa B binding activity and IL-2 levels were measured. In the clinical study, 150 consenting patients were randomized into 3 groups according to the analgesics used in them, namely, group morphine (M), group fentanyl (F) and group tramadol (T). IL-2 was measured preoperatively and 1, 3 and 24 h after operation. Consequently, NF-kappa B activation was suppressed by morphine and fentanyl but not by tramadol. IL-2 was significantly decreased by morphine and fentanyl but not by tramadol in vitro. In the PCA patients, IL-2 was decreased in group M and increased in group F postoperatively. Whereas in group T, IL-2 was unchanged 1 h after operation but was significantly elevated 3 and 24 h after operation. Our results showed that the inhibition of morphine on IL-2 was most probably related to its suppression on NF-kappa B. Fentanyl had different effects on human immune response in vitro and in vivo. Tramadol may have immune enhancing effect.
PMID: 17120754 [PubMed - indexed for MEDLINE]

Video-assisted Thoracic Surgery (VATS)

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Posted 22 Apr 2010 — by James Street
Category Thoracic Surgery

Cancer’s Top Killer Being Controlled By VATS

Features-2006-12-14-12-01-59Image1
At Danbury Hospital, new surgical options and a better understanding of lung cancer provide doctors with more information on how to treat it. Dr Michael Walker now operates in a new minimally invasive way with video-assisted thoracic surgery (VATS), which can offer patients an alternative to open surgery.
A diagnosis of lung cancer used to be a death sentence because in its early stages, the illness presented few symptoms. And by the time its effects begin to show, it was usually in an advanced stage, too late for a cure.

Today, however, new surgical options and a better understanding of the disease provide doctors with more information on how to treat it.

“Lung cancer is the No. 1 cancer killer of both men and women,” said Douglas Kahn, DO, Section of Pulmonary Disease. In fact, he said, it is affecting more women than ever, possibly because women are more susceptible to the carcinogens in smoke.

Dr Kahn spoke at a recent Danbury Hospital Medical Town Meeting, “An Update on Lung Cancer,” along with Michael Walker, MD, chief, Section of Thoracic Surgery, chairman, of the Lung Cancer Tumor Board and the Transplant Committee, and Marianne Mitchell, RN, APRN, coordinator of “Quit Now,” the hospital’s smoking cessation program.

The panel spoke to raise awareness that lung cancer can be prevented by not smoking, and to discuss treatment options, including a new kind of minimally invasive surgery.

While smoking puts a person more at risk, Dr Kahn said that other factors play a part, including exposure to radon, asbestos, chemicals, and air pollution.

“Still, tobacco use accounts for nearly 87 percent of all cases of lung cancer,” he said.

When lung cancer is found in the early stages (stage I and II), when it is most curable, Dr Walker can operate in a new minimally invasive way. Dr Walker is specially trained in video-assisted thoracic surgery (VATS), which he has been performing for more than a year, and can offer patients an alternative to open surgery.

Surgery to remove a lung tumor used to be very complicated and painful. Surgeons had to make much longer chest incision from front to back, and the ribs had to be spread. “It was a big deal,” said Dr Walker. “Spreading the ribs really hurt.”

He uses VATS mostly to remove tumors from the lungs in what is called a lobectomy. The procedure uses a special camera and a scope inserted through two small chest incisions.

The tumor is put into a bag to prevent spreading, or seeding, and is pulled out through an incision. It eliminates the need to painfully spread the ribs.

Dr Walker has already performed almost 50 VATS lobectomies.

Because it is minimally invasive, like so many procedures today, VATS promises less pain and a shorter hospital stay. Patients also recover more quickly and breathe better following surgery, according to Dr Walker.

When compared to the old-fashioned open procedure, he said, VATS is just as good, if not better.

For more information on lung cancer risks, contact your physician or visit www.danburyhospital.org, or call the Danbury Hospital Call Center at 866-374-0007.

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