Webcast puts spotlight on mesothelioma
By Joe O'Shea
A gifted thoracic surgeon, Dana-Farber's David Sugarbaker, MD, is
used to performing before crowds, but May 1 was probably the first time
he did so before an arena-sized gathering.
As part of the Brigham and Women's Hospital surgical webcast series,
Sugarbaker, chief of the Division of Thoracic Surgery at BWH, conducted
an extrapleural pneumonectomy live on the Web. According to BWH, a virtual
audience of 4,213 physicians, medical students, and others "tuned
in" to the second installment of this educational endeavor, including
observers from Japan and Germany. An additional 1,117 visitors viewed
the archived webcast in the five days following the surgery.
"For most patients who are treated, we're going for significant
life extension now," said Sugarbaker, who operated on a 78-year-old
male suffering from malignant pleural mesothelioma, an aggressive cancer
most often caused by asbestos exposure that occurs in the pleura, or
chest-wall lining, and often invades the lungs. "For the majority
of patients, a cure - at the present time - will not be in the cards.
But we're making progress."
Assisted by staff surgeon Jeanne Lukanich, MD, Sugarbaker removed the
patient's pleura, left lung, and diaphragmatic muscle, and then vigorously
scrubbed the chest cavity with a cytotoxic and bacteriocidal wash. The
team also rebuilt the diaphragm and created a dynamic pericardial patch
made of Gortex.
"Because of surgical innovations such as this, and subsequent
aggressive chemotherapy and radiation treatment, we have begun to improve
the survival rate within a subset of diagnosed patients," said
BWH associate surgeon Yolonda Colson, MD, PhD, who acted as webcast
commentator. Now, some mesothelioma patients'
lives are measured in years instead of months.
After Colson led off with an overview of the disease and surgery, Lukanich
walked the audience through several CT and MR scans depicting the extent
of the patient's cancer. "With the extension of the tumor into
the fissural surface of the lung," she said, "this patient
isn't considered a good patient for a pleurectomy [removal of the pleura,
not the lung] because removing the tumor from the fissure is very difficult."
An extrapleural pneumonectomy was called for instead. Although this
procedure isn't experimental - Sugarbaker first performed a similar
pleurectomy and aggressive chemotherapy wash on Margie Levine 14 years
ago (see related story, above) - it's not widely practiced due to its
"This procedure not only extends a patient's life, but also gives quality of life," noted Sugarbaker. "Teaching other surgeons how to do this will ultimately give some patients a welcomed treatment option."
To view this archived webcast, visit www.brighamandwomens.org/surgerywebcast.
Copyright 1990-present Joe O'Shea, Jr.