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Minimally Invasive Surgery a 'Lucky' Option for Woman's Early-Stage Lung Cancer

In an ironic way, Barbara Arvia is grateful for the bunion on her foot. Preparation for foot surgery led to a surprising diagnosis of lung cancer--and to state-of-the-art treatment at the University of Chicago Medicine.

Barbara Arvia Barbara Arvia

She explains, "My foot surgeon sent me for a routine chest X-ray at my local hospital before the bunion surgery." The X-ray showed a spot on her lung; a CT scan also identified the area of tissue abnormality; and a tissue biopsy confirmed the diagnosis of cancer. "Nobody was more shocked than me to learn it was lung cancer. I haven’t smoked in 25 years and I felt perfectly fine." Smoking is the major risk factor in more than 80 percent of all lung cancers.

Barbara considered herself lucky because her cancer was found early. Early detection and early treatment offer the best opportunity to fully eliminate any cancer.

The VATS procedure requires only three small incisions.

"Because Barbara’s lung cancer was at an early stage, she was an ideal patient for video-assisted thoracic surgery (VATS)," says Mark Ferguson, MD, a University of Chicago thoracic surgeon who specializes in surgery of the lung and esophagus, including minimally invasive surgery for lung cancer. A refinement of standard lung cancer surgery, VATS allows for removal of the cancerous lung lobe through an incision less than 2 inches long. This innovative procedure is primarily available only at leading academic hospitals such as the University of Chicago Medicine.

"VATS is an option for most small or peripheral lung tumors," says Dr. Ferguson. It offers best results with patients who have not undergone pre-operative chemotherapy or radiation therapy. For patients with larger tumors that have not spread, traditional open-chest surgery may be considered as a standard of care.

Removing Cancer Through Tiny Incisions

The VATS procedure requires three small incisions between the ribs: two 1/2-inch incisions that permit entry of a miniaturized video camera and surgical tools, and one 2-inch incision through which the surgeon operates and removes the diseased lobe or portion of a lung lobe. There is no need to spread the ribs to access the lungs.

"In addition to lung tissue, we typically remove all potentially affected lymph nodes at the root of the lung and center of the chest," says Dr. Ferguson. "Removing these lymph nodes provides more accurate information about the cancer stage and may prolong survival."

Mark Ferguson, MD Mark Ferguson, MD

Compared to standard surgery, the minimally invasive VATS approach offers patients a much faster and easier recovery. "There is considerably less pain with this approach, less inflammatory reaction in the surgical area, and less risk of side effects such as elevations in temperature or heart rate," says Dr. Ferguson.

For Barbara, the recovery was better than expected. She recalls, "Surgery was so easy. Two weeks after surgery I was back to exercising my lower body, and six weeks after surgery I was lifting weights for my upper body. Within three months, I was back to my full workout routine, including the elliptical and free weights."

Despite feeling great after surgery, Barbara and Dr. Ferguson are diligent about follow-up monitoring to detect any early signs of recurring cancer. Barbara sees Dr. Ferguson every few months, and he keeps her local doctor informed about her progress.

Barbara looks back: "Learning I had lung cancer, I was terrified. But Dr. Ferguson’s team and everyone I had contact with at the University of Chicago Medicine were wonderful and tried to make me feel comfortable."

She adds, "I was mentally prepared to have my whole chest opened for surgery and then to need chemotherapy and radiation therapy after the surgery. But the surgeons removed all the cancer through the minimally invasive method, and I didn’t need those other therapies."

"I feel blessed. I think sometimes you’re guided to the right people and I was."

September 2008