It didn’t take long before Dr. Luis Argote-Greene, the newly appointed Regional Director of Thoracic and Esophageal surgery at Cleveland Clinic Indian River Hospital, made important advances in the treatment of lung cancer here. Just a few weeks after his arrival in June, he and his team performed the hospital’s first anatomic robotic segmentectomy for lung cancer, a procedure that recently gained the support of thoracic surgeons worldwide.
Dr. Argote-Greene said the new treatment makes lung surgery less traumatic and notes a parallel between the evolution of lung surgery and the evolution of breast cancer surgery.
“Historically, treating breast cancer used to be a deforming surgery that involved removing the breast with underlying muscles. Later, with advances in oncology, surgery became a smaller, better tolerated multimodality treatment improving survival and quality of life for women around the globe.
“A similar evolution is taking place in the treatment of lung cancer. Lung cancer is a newer epidemic and until a few years ago a cure was rare. We now have better detection techniques like chest CT and screening, genomics and proteomics that allow us to find the cancer in very early stages. And we have less invasive surgical techniques like video-assisted and robotic surgery. With all the new advances we can perform a less invasive surgery that offers better chances of survival and better quality of life.”
Lung cancer has been called the largest epidemic of the 20th century, caused primarily from the use of tobacco products. Some of the earliest cases were treated with removal of the whole lung, but as advanced screening detected smaller spots of lung cancer in early stages, the treatment was reduced to just removing the infected lobe in a procedure called a lobectomy.
In 1995 a study compared survival rates of a lobectomy, which is the removal of the lobe where the cancer is located, to a lesser resection where just a section or wedge of the cancer infected area is extracted. In that study they found that patients who had the lobectomy lived longer than those who had the lesser resection.
Therefore, the standard of care since 1995 has been to do a lobectomy, which leaves patients with reduced pulmonary function.
But the Japanese continued to do lesser resections because they had smaller cancers, and a new trial was published last April after many years of collecting data. It determined that – in very early lung cancers, less than 2 centimeters in size – patients with a segmentectomy had a better survival rate than those who had a larger resection or lobectomy. The study found the less traumatic surgery saved needed tissue that is useful in the longer life of the patient, providing more lung function for a better quality of life.
“Nowadays we have the robotic platform which allows us to atomically dissect the bronchus (the windpipe that feeds that segment with air), and the pulmonary artery branches,” Dr. Argote-Green explained. “It’s technically challenging but with the robotic platform is like having your hands in there. We inject a florescent dye though the vein so it glows in the dark and which creates an anatomic resection so we can clearly see the real boundary of the infected segment.
Before we would estimate the boundary of the segment because we could see a slight change of color, but it was a real leap of faith. Now it’s safer and more precise.”
In robotic lung cancer surgery, the surgeon operates through four tiny incisions in the chest to remove the tumor and a certain amount of surrounding healthy tissue from the cancerous lobe.
During this minimally invasive surgery, four ports are inserted between the ribs and connected to the robotic platform. One arm holds a camera providing a three-dimensional view of everything going on in the chest. That leaves three ports for mechanical arms with tiny hands.
The surgeon can intricately manipulate the robotic arms to dissect and remove the diseased part of the lung. Most patients are up walking the same day and heading home the next.
The patient will return for a follow-up visit two weeks after the surgery for a new X-ray and the doctor will review the pathology. If it is negative, they’re done. Patients are then screened every six months to make sure the cancer has not reappeared or that another spot hasn’t developed.
Removing one spot doesn’t mean you won’t get another, but if you do the procedure can be repeated. Some patients may have two to four segmentectomys in their lifetime if needed.
The problem with lung cancer is that it usually has no symptoms until it’s too late. U.S. Preventive Services Task Force (USPSTF) suggests yearly lung cancer screening for at-risk people over the age of 50.
You are considered at risk if you currently smoke or if you’ve quit smoking in the past 15 years and you have at least a 20-pack year smoking history.
This number is calculated by multiplying the number of packs of cigarettes per day by the number of years smoked. For example, someone who smoked 2 packs a day for 10 years (2×10=20) has 20-pack years of smoking, as does a person who smoked 1 pack a day for 20 years (1×20=20). Getting a CT scan to detect cancer in its earlier stages increases the survival rate for those at risk by 20 percent.
“Two-hundred thousand people die every year from lung cancer,” Dr. Argote-Green continued. “We need to take away the stigma of being a smoker or ex-smoker and empower those at risk to seek help. Lung cancer is now curable if it’s found early enough.”
Dr. Argote-Greene earned his medical degree at Universidad Nacional Autonoma de Mexica and trained in General Surgery at the National Institute of Health Sciences and Nutrition Salvador Zubiran in Mexico City. He completed his Thoracic Surgery and Thoracic Oncology Clinical Fellowships at Brigham and Women’s Hospital and Harvard Medical School in Boston. Prior to joining Cleveland Clinic Indian River Hospital, Dr. Argote-Greene was a thoracic surgeon with University Hospitals in Ohio and clinical assistant professor at Case Western Reserve University.
He is now accepting new patients at Cleveland Clinic’s Health and Wellness Center, 3450 11th Court, Vero Beach. To schedule an appointment, call 772-563-4580.
