Thoracic Surgery


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Thoracic Surgery

  1. 1. Patient Care The University of Cincinnati thoracic surgeons care for patients with a range of benign and malignant thoracic disease. They perform the highest volume of lung cancer surgery in Cincinnati and provide leadership in the application of minimally invasive techniques through video-assisted thoraco- Walter H. Merrill, MD scopic surgery (VATS). Dr. Reed and Dr. Starnes also utilize John B. Flege, Jr. Professor sophisticated endobronchial and esophageal interventions for Chief, Section of complex airway and foregut disorders. The Division of Thoracic Cardiothoracic Surgery Surgery maintains active clinical services at University Hospital, Cincinnati VA Medical Center, and University Pointe. 513.584.3278 The Division specializes in the diagnosis and treatment of lung cancer and is dedicated to a multidisciplinary approach to the care of patients. The thoracic tumor boards at the University ofThe Division of Cincinnati and the Cincinnati VAMC are highly attended. They facilitate interdisciplinary collaboration between members of aThoracic Surgery variety of medical specialties, including Hematology-Oncology, Radiation Oncology, Pulmonary Medicine, Digestive Diseases, Radiology, and Pathology, in addition to Thoracic Surgery.The Division of Thoracic Surgery is a leader in treating the Special attention is directed to patients who are at high risk forentire spectrum of thoracic diseases including lung cancer, surgery due to underlying lung disease, thereby optimizingbenign and malignant esophageal disorders, and airway, treatment strategies without denying them the opportunity ofmediastinal, diaphragmatic, and chest wall diseases. The curative surgical therapy.Division offers particular expertise in minimally invasivethoracic procedures, including thoracoscopic (VATS) lobecto-my. Excellence is emphasized in patient care, education,research, and community service. The Division of Thoracic Surgery | Page 62
  2. 2. The Division offers a full range of lung cancer treatmentsfrom minor resections to highly complex thoracic opera-tions. The Division recently published a study on the intro-duction of thoracoscopic (VATS) lobectomy into an aca-demic practice. An important goal of the study was toevaluate the effectiveness and safety of incorporating anew technique into a program while also fulfilling theirresponsibility of teaching the technique to thoracic surgi-cal trainees, as well as community thoracic surgeons. Whilesome practices loosely define VATS lobectomy as anylobectomy using videoscopic assistance, the UC thoracicsurgeons strictly abided by the accurate definition ofthoracoscopic lobectomy: video-assisted lobectomy byanatomic hilar dissection with individual ligation ofstructures, complete lymph node sampling or dissection,and absolute avoidance of rib spreading.The percentage ofcases performed thoracoscopically has increased from 18%four years ago to 84% in the most recent 50 lobectomies.UC thoracic surgeons have performed more than 200 VATS Thoracic Surgery, Surgical Oncology, General Surgery,lobectomies. Digestive Diseases, Hematology-Oncology, and Radiation Oncology.A significant proportion of lung cancers require aggressivesurgical resection in conjunction with additional therapeu- Drs. Reed and Starnes have unique experience in severaltic modalities, including chemotherapy and radiation less common thoracic conditions. Dr. Starnes offers specialtherapy. The Division participates in a variety of multi-insti- expertise in the treatment of mediastinal tumors. She hastutional, collaborative oncology groups. A noteworthy exceptional knowledge of mediastinal germ cell tumorscurrent trial sponsored by the Southwest Oncology Group and thymomas. She also has an interest in VATS resection(SWOG) examines the role of neoadjuvant chemotherapy of posterior mediastinal tumors. Dr. Reed is an expert inand radiation therapy followed by surgery for patients airway disorders. He provides treatment for patients withwith superior sulcus (Pancoast) tumors. The Division has benign tracheal disease such as stenosis, tracheoe-enrolled a number of patients in this trial, performing the sophageal fistula, and tracheoinnominate fistula. He alsocomplex lung and chest wall resection after completion of performs operations for the resection of tracheal andneoadjuvant therapy. In collaboration with the Division of bronchial tumors. They also both offer VATS sympathecto-Radiation Oncology, Dr. Reed and Dr. Starnes also partici- my for hyperhidrosis and VATS splanchnicectomy for debil-pate in an innovative trial, sponsored by the American itating pancreatic pain.College of Surgeons Oncology Group (ACOSOG), for lungcancer patients who are at high risk for surgery due to Members of the Division of Pulmonary, Critical Care, andsevere chronic obstructive pulmonary disease. In order to Sleep Medicine at UC are world renowned experts in twopreserve lung function while still achieving sufficient local rare diseases, lymphangioleiomyomatosis (LAM) and pul-control of the cancer, patients are randomized to receive monary alveolar proteinosis (PAP).They collaborate clinical-sub-lobar resection with or without brachytherapy. ly and scientifically with the Division of Thoracic Surgery. Patients with pleural complications of LAM such as pneu-The Division works closely with university and community mothorax and chylothorax frequently require surgicalmedical and radiation oncologists to manage advanced intervention. The UC thoracic surgeons employ VATSlung cancers. This includes palliative therapy for patients approaches to the management of these complicatedwith complications of unresectable lung cancer. For exam- patients. For patients with PAP, sequential whole lungple, malignant pleural effusions are treated by VATS pleu- lavage is performed in the operating room under singlerodesis or placement of tunneled pleural (Pleurx®) lung isolation.catheters. Airway complications are managed by bothendobronchial ablative therapy (resection, laser, photody-namic therapy - PDT, or argon plasma coagulation - APC)and stenting via flexible and rigid bronchoscopy.In addition to their high volume of pulmonary surgery,the Division of Thoracic Surgery also concentrates onesophageal disease. The UC Esophageal Center, a multidis-ciplinary program devoted to the management of the widearray of benign and malignant esophageal disorders, wasrecently established at the Barrett Cancer Center. Directedby Dr. Reed, this collaborative effort brings togetheresophageal experts from a variety of disciplines, including The Division of Thoracic Surgery | Page 63
  3. 3. Education the Trauma Division, they are studying traumatic diaphrag- matic injuries. They have also studied the role of VATS forSurgical training is an important role of the Division of the management of acute thoracic trauma. In collaborationThoracic Surgery. The ACGME-accredited residency in with Interventional Radiology, they have evaluated the effi-thoracic surgery has graduated two trainees, Dr. John cacy of tissue plasminogen activator (TPA) for the manage-Mehall in 2007 and Dr. Jeffrey Garrett in 2008. Two resi- ment of parapneumonic effusions.dents, Dr. Julian Guitron and Dr. Lynn (Chip) Huffman,continue in the residency at this time, and Dr. Dana Booth Dr. Francis McCormack and his colleagues in Pulmonarywill begin in 2009. This program provides three continuous Medicine have worked with Dr. Reed and Dr. Starnes toyears of clinical training in cardiac and thoracic surgery.The study the impact of pleural interventions for LAM on lungthoracic residents receive unique training in minimally transplantation. In one project they defined managementinvasive thoracic surgery. Their experience was a critical preferences for treating the pleural complications of LAM.focus of the study on the safe introduction of thoraco- In another study they determined lung transplantscopic lobectomy into an academic training program, exclusion criteria. Together they are currently studying thepresented at the Western Thoracic Surgical Association surgical treatment of pneumothorax and associated recur-2007 meeting, and published in 2008 in the Journal of rence rates.Thoracic and Cardiovascular Surgery. An important ongoing divisional project has been theThe Division also trains general surgery residents who Thoracic Tumor Registry, directed by Dr. Starnes. It hasrotate on the service at the University Hospital during their accrued over 400 patients, with over 250 tumor specimensfourth year and at the Cincinnati VAMC during their fifth stored in the tissue bank. This valuable resource serves ayear. All graduates of the UC surgery residency finish with key role in current and future translational and molecularan operative thoracic surgical experience far in excess of studies of lung cancer. Dr. Starnes also directs the lungrequirements. Medical students from the University of cancer outcomes database which has enrolled over 200Cincinnati College of Medicine rotate on the service as part patients, and she serves as director of the multidisciplinaryof their third year surgery clerkship, and during elective UC Lung Cancer Research Group.fourth year subinternships. Medical students also partici-pate in the outpatient Thoracic Surgery Clinics as part of Dr. Reed’s laboratory is located at the Vontz Center forthe Clinical Oncology Elective. Molecular Studies. His research focuses on the retinoblas- toma (RB) tumor suppressor in therapeutic response inThe Division of Thoracic Surgery is also dedicated to lung cancer. His recent studies have been published intraining specialists in other fields. For example, it provides numerous peer-reviewed journals including Canceran elective rotation for Pulmonary Medicine fellows. Research, Oncogene, Molecular and Cellular Biology, JournalDr. Reed and Dr. Starnes frequently lecture at teaching con- of Surgical Research, and Annals of Thoracic Surgery.ferences or grand rounds in Pulmonary Medicine, Head andNeck Surgery, Radiation Oncology, and Internal Medicine. Dr. Starnes focuses on translational lung cancer research.Finally, they have spoken, and been shadowed, during the She has established a productive collaboration with Dr.UC Summer Surgery Experience for undergraduate Marshall Anderson and Dr. Jorge Moscat from thestudents contemplating a career in medicine. Additionally, Department of Cell and Cancer Biology to study molecularDr. Starnes and Dr. Reed have served as mentors for a markers in early lung cancer as predictors of clinical out-unique program developed by the American Association come. Dr. Starnes also works with Dr. Tim LeCras fromfor Thoracic Surgery, where first-year medical students Cincinnati Children’s Hospital Medical Center, looking atfrom throughout the United States spend eight dedicated the role of pleiotrophin in lung cancer.weeks on a cardiothoracic surgery service.ResearchThe Division continues to expand its expertise in research.Dr. Starnes directs the American College of SurgeonsOncology Group (ACOSOG) lung cancer trials at UniversityHospital and the Cincinnati Veterans Affairs Medical Center.UC thoracic surgeons also participate in a number of trialssponsored by the Southwest Oncology Group (SWOG). TheDivision of Thoracic Surgery, in collaboration with oncolo-gy, offers clinical trials for every stage of lung cancer.Dr. Reed and Dr. Starnes also serve as investigators for anumber of clinical research projects. They are currentlyenrolling patients in their study of the role of endoscopicultrasound (EUS) and endobronchial ultrasound (EBUS) inmediastinal staging of lung cancer. In collaboration with The Division of Thoracic Surgery | Page 64
  4. 4. Community ConnectionsCommunity service is a critical mission for the Division ofThoracic Surgery. The primary service strategy has beenthrough a focus on education. Dr. Starnes has spoken at avariety of community events on lung cancer in women andthe impact of cigarette smoking on women’s health. Shehas also led discussions at a number of community physi-cian teaching events. Drs. Reed and Starnes have beenactive participants in the UC Cancer Center CommunityEducation Day and the UC Lung Cancer Symposium.Cincinnati is the site of the annual International LAMSymposium. Dr. Reed has been an invited speaker at thisevent, delivering talks to patients and families, discussingsurgical pleural interventions, as well as pneumothorax. Hehas also met with smaller patient and family groups forlunchtime table talks.Dr. Reed and Dr. Starnes continue to act as spokespersonsfor lung cancer education through the news media, fre-quently giving interviews and offering thoracic expertise.FacultyMichael F. Reed, MD, FACSAssociate Professor of SurgeryDr. Reed specializes in general thoracic surgery, focusing onlung cancer and esophageal disease. He has particularexpertise in tracheal disorders and is an expert in minimal-ly invasive thoracic surgery. He is certified by the AmericanBoard of Surgery and the American Board of ThoracicSurgery.Sandra L. Starnes, MD, FACSAssistant Professor of SurgeryDr. Starnes specializes in general thoracic surgery with afocus on lung and esophageal cancer. She has a particularexpertise in treating mediastinal tumors and focuses onminimally-invasive approaches to thoracic surgery. Sheis certified by the American Board of Surgery and theAmerican Board of Thoracic Surgery.Further information on the Division of Thoracic Surgery canbe viewed on our website The Division of Thoracic Surgery | Page 65