Thoracic & Cardiovascular Surgery

The department hosts an active Lung Cancer Screening Program for current and former smokers to help detect lung cancer at its earliest stage, when treatment is most effective.

The Vascular Surgery Program provides diagnostic evaluation, medical, endovascular and operative care to cancer patients and survivors with various forms of vascular disease. 

The department's robust minimally invasive surgery program is focused on reducing the pain and trauma associated with conventional open surgery. The program routinely performs video-assisted thoracic surgery (VATS) and robotic-assisted surgery for lung, thymic and esophageal cancers. Approximately 80% of early stage lung cancer is resected using minimally invasive techniques. A recent review of nearly 1,000 MD Anderson cases revealed that these techniques cut in half the number of postoperative complications. Minimally invasive surgery is also part of the department's enhanced recovery pathway. Read more about the program in the publications listed below.

1. Nelson DB, Mehran RJ, Mitchell KG, Rajaram R, Correa AM, Bassett RL Jr, Antonoff MB, Hofstetter WL, Roth JA, Sepesi B, Swisher SG, Walsh GL, Vaporciyan AA, Rice DC. Robotic-Assisted Lobectomy for Non-Small Cell Lung Cancer: A Comprehensive Institutional Experience. Ann Thorac Surg. 2019 Aug;108(2):370-376. doi: 10.1016/j.athoracsur.2019.03.051. Epub 2019 Apr 18. PubMed PMID: 31004583.
2. Stephens N, Rice D, Correa A, Hoffstetter W, Mehran R, Roth J, Walsh G, Vaporciyan A, Swisher S. Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-small-cell lung cancer: a propensity-matched analysis of 963 cases. Eur J Cardiothorac Surg. 2014 Oct;46(4):607-13. doi: 10.1093/ejcts/ezu036. PubMed PMID: 24603446.

The Enhanced Surgical Recovery Program in Thoracic Surgery results in reduced symptoms, improved function and quicker return to normal activities and additional needed treatment. This program uses the principles of optimal perioperative care pathways as the foundation of their program. These principles include avoiding long periods of fasting, reducing patient anxiety through education and expectation setting, minimizing narcotic use and using goal-directed fluid therapy. Thoracic Surgery, in particular, has implemented elements such as preventive, multimodal and regional pain control, early ambulation and return to nutrition, modulation of inflammation and prevention of post-operative nausea. Read more about the program in the Enhanced Recovery Program Fiscal Year 2019 Annual Report  and in the recent publications below.   

1. Nelson DB, Niu J, Mitchell KG, Sepesi B, Hofstetter WL, Antonoff MB, Giordano SH, Mehran RJ, Rice DC. Persistent Opioid Use Among The Elderly After Lung Resection: A SEER-Medicare Study. Ann Thorac Surg. 2019 Aug 22. pii: S0003-4975(19)31216-0. doi: 10.1016/j.athoracsur.2019.06.095. [Epub ahead of print] PubMed PMID: 31445908.
2. Nelson DB, Cata JP, Niu J, Mitchell KG, Vaporciyan AA, Antonoff MB, Hofstetter WL, Giordano SH, Sepesi B, Mehran RJ, Rice DC. Persistent opioid use is associated with worse survival after lobectomy for stage I non-small cell lung cancer. Pain. 2019 Oct;160(10):2365-2373. doi: 10.1097/j.pain.0000000000001630.  Pubmed PMID: 31149979.
3. Nelson DB, Mehran RJ, Mitchell KG, Correa AM, Sepesi B, Antonoff MB, Rice DC. Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019 Jul;158(1):279-286.e1. doi: 10.1016/j.jtcvs.2019.03.009. Epub 2019 Mar 21. PubMed PMID: 31014665.
4. Marcus RK, Lillemoe HA, Rice DC, Mena G, Bednarski BK, Speer BB, Ramirez PT, Lasala JD, Navai N, Williams WH, Kim BJ, Voss RK, Gottumukkala VN, Aloia TA. Determining the Safety and Efficacy of Enhanced Recovery Protocols in Major Oncologic Surgery: An Institutional NSQIP Analysis. Ann Surg Oncol. 2019 Mar;26(3):782-790. doi: 10.1245/s10434-018-07150-5. Epub 2019 Jan 9. PubMed PMID: 30627879.
5. Van Haren RM, Mehran RJ, Mena GE, Correa AM, Antonoff MB, Baker CM, Woodard TC, Hofstetter WL, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rice DC. Enhanced Recovery Decreases Pulmonary and Cardiac Complications After Thoracotomy for Lung Cancer. Ann Thorac Surg. 2018 Jul;106(1):272-279. doi: 10.1016/j.athoracsur.2018.01.088. Epub 2018 Mar 9. PubMed PMID: 29530770.
6. Mehran RJ, Martin LW, Baker CM, Mena GE, Rice DC. Pain Management in an Enhanced Recovery Pathway After Thoracic Surgical Procedures. Ann Thorac Surg. 2016 Dec;102(6):e595-e596. doi: 10.1016/j.athoracsur.2016.05.050. PubMed PMID: 27847094.
7. Mehran RJ, Walsh GL, Zalpour A, Cata JP, Correa AM, Antonoff MB, Rice DC. Intercostal Nerve Blocks With Liposomal Bupivacaine: Demonstration of Safety, and Potential Benefits. Semin Thorac Cardiovasc Surg. 2017 Winter;29(4):531-537. doi:  10.1053/j.semtcvs.2017.06.004. Epub 2017 Jun 6. PubMed PMID: 29698654.
8. Shi Q, Wang XS, Vaporciyan AA, Rice DC, Popat KU, Cleeland CS. Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer. J Pain Symptom Manage. 2016 Dec;52(6):822-831. doi: 10.1016/j.jpainsymman.2016.07.005. Epub 2016 Aug 10. PubMed PMID: 27521528.
9. Rice DC, Cata JP, Mena GE, Rodriguez-Restrepo A, Correa AM, Mehran RJ. Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to Thoracic Epidural Analgesia. Ann Thorac Surg. 2015 Jun;99(6):1953-60. doi: 10.1016/j.athoracsur.2015.02.074. Epub 2015 Apr 23. PubMed PMID: 25912739.

The department’s Endoscopic Mucosal Resection Program treats early stage esophageal cancer. Such techniques avoid the need for removing the esophagus and replacing it. This means patients can continue to swallow and eat normally. This multidisciplinary program has been very successful at proving organ-sparing techniques are appropriate for early stage disease and result in a high cure rate.