Dr. Stephen Broderick discusses his use of advanced procedures and the benefits to lung cancer patients, especially those with compromised pulmonary function, the elderly and former smokers.
My name is Stephen Broderick. I'm an assistant professor of surgery at Johns Hopkins Medicine. I practice in the greater Washington region, and I'm the division director for quality and patient safety for the division of Thor ASIC. Surgery. Lung sparing surgery refers to the fact that traditionally an an atomic Loeb ectomy, so removing one of the five lobes of the lung was the standard of care for any early stage lung cancer undergoing pulmonary resection. There's substantial evidence now to suggest that for smaller tumors in anatomically appropriate positions, uh, less than a lumpectomy is an appropriate oncological outcome. So an an atomic segment ectomy, where an individual segment of a lobe is removed, or a composite of two or three segments, or a wedge resection, which is simply a reflection of the legion itself with a generous pulmonary margin. Thes procedures air beneficial for certain patients who have smaller tumors in anatomically appropriate locations on particularly for those with already compromised pulmonary function. So many of our patients are former smokers or perhaps elderly patients who have limited lung function. And if we're able to spare some pulmonary parang coma while still performing and ecologically appropriate operation we can optimize their pulmonary outcomes. Certainly there are tumors that require an anatomical OPEC to me based on size, generally lesions that are over two centimeters in size. We do recommended an atomic Loeb ectomy or location. So if the lesion is centrally located within a lobe, there isn't really a great sub low bar option for resection. So for those patients, we proceed within an atomic lumpectomy. But for many patients were able to perform an an atomic segment ectomy or sub low bar resection, which preserves pulmonary function. This'll Woman is a 73 year old lady who we evaluated for an early stage, non small cell lung cancer. She initially developed a cough for which her primary care doctor have turned, attained a chest X ray and then C T scan. And they found this lesion in the A pickle division, or the top half of the upper lobe. It was suspicious on C T scan as well as pet imaging, but not amenable to any of our standard biopsy techniques based on the degree of suspicion of the lesion. And it's an atomic location. We took her to the operating room for resection. She had somewhat limited pulmonary function but traditionally would have undergone on an atomic lumpectomy. But based on the location of this lesion and its size, we were able to perform what we call a Lingle er, sparing upper low back to me. So we respected just the upper division of the upper lobe, thereby sparing her some pulmonary function. She made an outstanding recovery. She has terrific postoperative pulmonary function. Uh, we preserved her quality of life, and she's had a terrific ankle logic outcome with no evidence of recurrence and a stage one respected lung cancer. Other procedural aspects of care we provide in the greater Washington area is the advancement of minimally invasive techniques for longer section. So the vast majority of our pulmonary sections now are performed through minimally invasive or Thor Chris Coptic techniques. Even when we do perform an open procedure, it's through a much smaller incision, often muscle sparing incisions that enhance patient's recovery. In addition, across the spectrum of lung cancer care From a procedural standpoint, we're able to offer all of the latest endoscopic techniques for media style staging so as, uh, lung cancer physicians and is a a lung cancer surgeon. Uh, Not only am I involved in removing the tumor, but we're involved in the preoperative and intra operative staging, which is a critical aspect of a programmatic approach. The lung cancer care so identifying patients early, who have more advanced tumors and need additional therapy. So we're able to perform endoscopic ultrasound guided lymph node biopsies with our colleagues and interventional pulmonologist, as well as navigational bronchoscopy guided biopsies of pulmonary nodules. We also have an outstanding team of interventional radiologists who perform per cutaneous biopsies with some regularity for us eso in our program at the Sydney Kimmel Cancer Center, we're really focusing on a programmatic, multi disciplinary approach to the care of patients with lung cancer, and that may, for many patients with early stage disease include surgery and and potentially Onley surgery. But we also want to bring to bear the re sources and opinions and expertise of all the providers in radiation oncology, medical oncology, interventional pulmonologist, uh, pathology, A swell as other specialties such as integrative medicine and nutrition and palliative care. When that's appropriate, um, to really focus on an individual patient and optimizing their their outcomes from from screening and initial diagnosis, all the way through the spectrum of cancer care to palliative care, primary care physicians, internal medicine physicians, pulmonary physicians are a crucial part of the multi disciplinary team. They often know the patients the best, have the longest track record with them and are familiar with their goals and priorities. So after an initial evaluation at the thoracic Center, we will have a person to person discussion of an individual patient's case. Um, go over the imaging findings pathology findings on our recommendations for how to proceed on. Then keep that physician abreast of the patient's progress. Uh, peri operatively on and moving forward with their long term surveillance, uh, for oncology purposes.
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