February 23, 2012

Surgical teamwork boosts cancer patient’s odds

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Ronald Denton is recovering from surgery to repair damage to his spine caused by a tumor. (photo by Anne Rayner)

Surgical teamwork boosts cancer patient’s odds

The first surgery Eric Grogan, M.D., and Matthew McGirt, M.D., performed together lasted 18 hours. Grogan, a thoracic surgeon, carefully cut away the baseball-sized lung tumor that had wrapped around patient Ronald Denton’s aorta, subclavian artery and esophagus and removed the upper lobe of the lung.

After they worked together to remove three vertebrae that the tumor had invaded, McGirt, a neurosurgeon, rebuilt and reinforced the vertebrae that had been destroyed by the encroaching tumor.

Eric Grogan, M.D.

Eric Grogan, M.D.

Matthew McGirt, M.D.

Matthew McGirt, M.D.

For Denton, their teamwork equaled a greater chance at survival.

“Most surgeons and oncologists would deem this tumor unresectable, but with the right multidisciplinary team a surgical cure may be achieved,” Grogan said.

“At Vanderbilt, we have the combined expertise in both complex spine reconstructive surgery and complex thoracic surgical oncology to perform these types of cases and improve people’s survival.”

The standard of care for stage III lung cancer like Denton’s is typically radiation and chemotherapy to try to halt the tumor’s progression. But for patients whose tumors have not spread to other vital organs, surgically removing the tumor can reduce local recurrence rates and increase survival rates.

“Without our multidisciplinary team, the surgical cure is not an option and Mr. Denton’s five-year survival would have been approximately 10-15 percent with a high rate of local recurrence and potential paralysis. Now, we can estimate that he has a 20-40 percent, five-year survival,” Grogan said.

Given their proximity in the body, the partnership between thoracic and spine surgery at Vanderbilt is not new, but its strong foundation and continued collaboration are giving lung cancer patients new treatment options.

“This opens up a whole new world of treatment in Tennessee for this disease. Having the multidisciplinary team we currently have gives patients a potentially curative option that didn’t exist before,” McGirt said.

Denton, 64, from Bowling Green, Ky., served four years in the U.S. Marine Corps during the Vietnam era and retired after 33 years with the Eastman Kodak Co.

After a shoulder replacement surgery last September at the Veterans’ Affairs Tennessee Valley Health System, he had one final scan before being released, which revealed the primary lung tumor.

“I was born at home and had never been in the hospital a day in my life,” Denton said. But he was about to start a medical care marathon. First, tests to see if he was healthy for surgery revealed that Denton needed three stents in his heart. Feeling fit and healthy, he was baffled.

“I walk four miles a day in one hour at the mall. I had no shortness of breath, no pain, nothing,” he said.

Then the tumor was found to be extremely fast-growing and severely encroaching on the spine. Oran Aaronson, M.D., the neurosurgeon who had been consulting on the case at the VA Hospital, knew that McGirt’s expertise in reconstruction would be needed and introduced him to Grogan.

“The spine reconstruction needed is individualized to the patient and the resection needed to clear all the cancer. It’s a challenging surgery that requires multiple people on the right teams to pull it off. I’m glad we could all come together and be successful,” McGirt said.

“I was amazed to see what Eric could do inside the chest cavity, and I think he felt the same way when we were working around the exposed spinal cord.”

With the tumor removed, Denton is now having chemotherapy and radiation to ensure all cancer cells are killed. He is still experiencing back pain and must wear a brace, but hopes to get back to his mall-walking regimen soon and doesn’t regret opting for surgery.

“I had great confidence in my doctors. I didn’t know what would happen, but I put it into God’s hands because I’m a man of faith. I’d rather I didn’t have this, but God doesn’t always do things the way we want.”