Due to high rates of smoking among its citizens, China is experiencing high rates of lung cancer. But surgeons are able to catch lung cancer earlier than in America because Chinese citizens are required to get lung screenings, according to Manatee Memorial Hospital thoracic surgeon Ron Smith, M.D.
If cancer is found early, many times the treatment in China is the new uniportal video-assisted thoracic surgery, or VATS. That treatment is only done by a handful of surgical teams in America, and one such team is Smith’s at Manatee Memorial Hospital.
The new lung cancer surgery that involves only a two-inch incision is proliferating in China and Smith, his certified surgical first assistant Kayla Fritze and his physician assistant Darius Taylor were invited to China to see it performed first hand.
On their trip, they learned that something remarkable happened in China when the government forced its citizens to have lung cancer screenings, not primarily due to air pollution, but the country’s high smoking rates, Smith said.
Chinese doctors began diagnosing lung cancer at early stages, even in young patients, and the new surgery that has exploded in China has begun curing it in 90 percent of cases, Smith said.
Although the United States does not force its citizens to have lung cancer screenings, Smith and his team believe that Manatee County lives will be saved if residents who smoke or have had chemical exposure would voluntarily have lung cancer screenings before they have symptoms, such as coughing, shortness of breath or chest pain.
If they do, Smith believes he and his team can increase their chance of survival from lung cancer.
“The lung cancer screening is so important,” said Smith who was invited to speak at a VATS symposium in China during his roughly two-week visit in early March. “This is a disease that kills 85 percent of people who get diagnosed with it. Only 15 percent of people are survivors. That number could go way, way, higher if we screen more people.
“If you are at risk and know you are at risk, you can get screened and it might show you have an early lung cancer. If you have an early lung cancer, there is a 90 percent chance we can cure you with a two-inch incision.”
Although there are many locations in Manatee to have lung screenings, The Lung Institute at Manatee Memorial Hospital has been designated a Lung Cancer Screening Center by the American College of Radiology, said MMH nurse navigator Kelsie Fryrear.
Manatee Memorial’s screening center uses a low-dose CT scan, which can detect the cancer at early stages, Fryrear said. A physician’s prescription is required and the cost can be picked up by insurance or cost around $90 for patients without insurance.
Eligibility includes those age 55-77, heavy smokers or those who have quit in the past 15 years and have no symptoms, Fryrear added.
In a thoracotomy, which was the only lung cancer surgery treatment before robotic surgery and VATS, and which is still preferred by many U.S. surgeons, according to Smith, the entire chest is opened in a cut often called a “shark bite” due to its size.
The surgeon then places his or her hand in the patient’s chest to remove a cancerous lung lobe.
Post surgery pain, sometimes for months or even years due to the rib-spreading, along with the chance of fatal infection and dealing with a shark bite-size scar, all make a thoracotomy a challenge for patients, Smith said.
But in VATS, the surgeon makes a two-inch incision in the side of the chest and stands by as a camera operator, in Smith’s case both Fritze and Taylor, winds a tiny camera through the incision to the lung area where high-definition pictures are relayed to a monitor, Smith said.
Using highly specialized surgical tools put through the tiny incision, and only the pictures he is seeing, the surgeon carefully cuts out the diseased lung lobe, puts it in a bag and then slowly pulls the bag back through the incision, without having to open the entire chest.
Smith believes that one reason why VATS hasn’t caught on in the United States is that the procedure is very difficult to learn.
“The human anatomy is very unforgiving,” Smith said. “We are dealing with very fragile blood vessels that are coming out of the heart and going back into the heart. You have to learn how to carefully manipulate the blood vessels so you can safely divide them and not injure them. I tell all my patients that these are big operations that we do through small incisions.”
VATS has exploded in Europe and Asia
The number of VATS surgeries has rocketed in the past 20 years in Asia and Europe, according to the Journal of Thoracic Disease, leading to improvements in technique and camera systems, and generating patient demand.
But America is lagging behind. At least so far.
Smith has been doing approximately 100 VATS surgeries a year at Manatee Memorial and is among America’s leaders in the procedure.
Spanish surgeon Dr. Diego Gonzales-Rivas is the pioneer of VATS, Smith said.
When Gonzales-Rivas heard that Smith and his team were doing VATS at Manatee Memorial Hospital, he invited them to come to Shanghai Pulmonary Hospital, where he has come from Europe to be the hospital’s chief surgeon and supervise 40 to 50 lung cancer surgeries performed daily.
“There are more lung cancer operations performed there every day than anywhere in the world,” Smith said of Shanghai Pulmonary Hospital.
“One day that we were there, we did 76,” Smith added.
Smith and his team were surprised at some of the differences between the Chinese hospital and Manatee Memorial, such as that Chinese patients walk to the operating room and often sit in chairs and wait for the room to be cleaned from the last patient, and that a Chinese operating room doesn’t have near the equipment that a U.S. one does.
“We would never let a patient walk by themselves to the operating room,” Fritze said with a grin. “The Chinese get more out of less.”
“They are very focused in the operating room,” Taylor said. “If a case is going badly, I would see them use technique to get themselves out of danger and just move on. Nothing deters them.”
“Yes,” Smith said, hearing Taylor’s assessment. “For the Chinese, technique is more important than technology.”
‘Cool Hand Luke’
Fritze and Taylor give credit to Smith for being persistent in mastering the procedure for his patient’s sake.
“I call him, ‘Cool Hand Luke,’ ” Taylor said of Smith, recalling the Paul Newman character in the movie. “It’s all business. We’re focused on what we have to do. We are maneuvering around very delicate vessels and structures inside the chest. You have to have a surgeon who has a steady hand.
Fryrear believes Bradenton and Manatee Memorial Hospital are destined to become nationally famous for VATS.
“We believe that when word gets out about Dr. Smith’s skill with VATS, it will create a demand at MMH,” Fryrear said.
“This is a technique that is, perhaps, only done in a handful of places in the country, but it is done right here in Bradenton,” Taylor said. “You don’t have to drive to Tampa or Gainesville because it is not done in those places. We are talking about a top-notch technique being used in Manatee County. Personally, that’s what excites me about it. I don’t have to go to Shanghai to perform this technique. I think that’s pretty slick.”
To contact Dr. Smith, call Pam Foley at 941-744-2640.