Worcester, Massachusetts — For most patients, the diagnosis and surgical treatment of early cancerous lung tumors is a lengthy process.
“In about 99% of hospitals in the country, it takes about a week to have a bronchoscopy, a biopsy, and a diagnosis,” said Mark Maxfield, MD, thoracic surgeon at UMass Memorial Health. “Then they come back and meet with the surgeon, discuss the operation, and then schedule the operation and then he has to wait two weeks, three weeks, or he has to wait four weeks.”
This is not only painful for the patient.
But UMass Memorial Health has been using a different approach for about a year now. Diagnosis and removal of cancerous lung tumors all in one morning. This procedure is called RODAT.
“This is one robotic anesthesia diagnosis and treatment,” says Maxfield. “The idea here is that someone who has a pulmonary nodule that is worrisome can come in, have a bronchoscopy, be diagnosed, and possibly have surgery if it is malignant.”
This means that once the patient is sedated, they will not wake up until the cancer may be removed. The whole process takes about 3-4 hours.
“From the patient’s perspective, they’re going to have two different procedures on two different days, and it’s horrendous for them to go through that,” said Maxfield. We did it first in New England, but there are only a handful of centers in the country that have figured out how to do it. ”
RODAT is best if a previous CT screening scan (recommended annually for smokers over age 50 and recent quitters) detected suspicious nodules. This is usually stage 1 lung cancer. But Maxfield said he could treat rare stage 2 tumors using RODAT.
This procedure is not suitable for advanced lung cancer. Unfortunately, 70% of lung cancers diagnosed in the United States reach stage 3 or 4. A CT screening would undoubtedly reduce that number, but Maxfield believes he receives less than 10% of those eligible for such screening. It is
UMass Memorial Health invited Boston 25 News to watch the RODAT surgery this week. The patient was a 67-year-old woman. Her CT scan showed a blueberry-sized tumor deep in her right lung. Unfortunately, imaging alone cannot determine malignancy, but she was an excellent candidate for her RODAT surgery.
A pulmonologist, in this case Rahul Sood, MD, will perform a bronchoscopy to both view and biopsy the tumor. This part of the procedure requires passing a fluoroscope several feet through a small lung passageway.
“Using the robotic bronchoscopy procedure, we can go deeper into the lung tissue than we were able to do with previous equipment,” says Sood. “Once you reach the nodule, take a small piece of it.”
These fragments are rushed to a pathologist, Dr. Andrew Fisher. He uses advanced technology to help make a diagnosis in about 15 minutes. His challenge in this case: The initial microbiological samples did not prove conclusive in any way.
“We have to be very careful with these cases,” he said.
A subsequent sample clarified the patient’s situation and clearly demonstrated an early-stage adenocarcinoma of the lung.
“The good news in this case is that it’s a relatively indolent tumor and was discovered at an early stage,” Fischer said.
The patient remained sedated during this entire period. It was waiting in case the tumor had to move out, so to speak.
That task fell to Maxfield, who controlled the robotic aspects of the procedure from the console. On the screen, we see small scissors, gauze, and even his marking pen guided into the lung cavity by a robot. And suddenly, a tumor develops and Maxfield begins removing it.
“If this patient was at a facility other than UMass, there would be an additional weeks or months of delay before she actually had the cancer removed,” Fischer said. “She will have it excised today and will probably go home tomorrow.”
Five-year survival rates for stage 1 lung cancer range from 70% to over 90%, but decrease dramatically as the cancer progresses.
Get screened annually if you smoke or have been a smoker, says Maxfield.
“Lung cancer CT screening scans are one of the best screening tools to prevent and identify cancer early,” he said.
This is a developing story. Check back for updates as more information becomes available.
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