Improving Outcomes Through Basic and Clinical Research

From the 2014 Department of Surgery Annual Report

Thoracic surgeonsThoracic surgeon Traves Crabtree, MD, pointing, and radiation oncologist Cliff Robinson, MD, consult over CT scans to plan radiation therapy. IN 1933, Department of Surgery Chair Evarts Graham, MD, performed the first surgical removal of a lung, in Dr. James Gilmore, a 49-year-old obstetrician from Pittsburgh. The surgery is notable not only as a medical milestone, but for the long life it afforded Gilmore; he outlived Graham, who died of lung cancer in 1957.

Washington University thoracic surgeons have made many other contributions advancing clinical care. Among them, Thomas Burford, MD, who took over the Barnes Hospital thoracic surgery service in 1951, helped develop protocols for hemothorax, or blood in the chest, that were used in World War II and are still used in trauma centers. Thoracic surgeons at Barnes-JewishHospital established one of the country’s earliest lung transplantation programs in 1988 and performed the first lung volume reduction surgery in the world to improve breathing in emphysema patients in 1993.

In research today, the National Institutes of Health (NIH)-funded Thoracic Immunobiology Lab has made key discoveries in the causes of lung transplant rejection. Additionally, thoracic surgeons have collaborated with radiation oncologists on many studies comparing outcomes in patients with non-small cell lung cancer treated with either surgical removal of a portion of the lung or stereotactic body radiation therapy.

The collaboration on outcomes research has carried over to treatment, as both specialist groups evaluate what’s best for individual patients.

“We’ve become increasingly aware of the gray zone in patients who could be treated with either surgery or radiation therapy,” says Bryan Meyers, MD, MPH, section chief and the Patrick and Joy Williamson Professor of Surgery. “What we have come to understand is that there is not always a right objective answer for many patients, so the right answer mightbe what works best for them in a personal and subjective sense.”

Cooperation is also taking place in planning radiation treatment, with thoracic surgeons viewing a CT scan to share their input on where to deliver radiation to target the tumor and exclude any important anatomic structures.

Addressing federal government pressures and institutional goals, surgeons and radiation oncologists are creating an accredited care organization with Barnes-Jewish Hospital to plan care for lung cancer patients, with the aim of improving efficiency and outcomes.

“I thought the hardest thing would be to get people to accept the notion of it,” says Meyers. “So far, they’re on board.”