Director of Robotic Thoracic Surgery at the University of Utah Huntsman Cancer Institute, Brian Mitzman, MD talks about a new procedure that helped treat this grandfather so he can live to see many more grandkids.
Interview conducted by Ivanhoe Broadcast News in 2022.
Lung cancer is kind of a hard cancer because it’s not always easy to detect and see, right?
MITZMAN: Correct. So what we know about lung cancers, when you look at all stages, the five-year overall survival is only about 20% and that’s really low. It’s the leading cancer killer in men and women nationally. But if we can catch lung cancer early, Stage 1 lung cancer, that cure rate is over 90%. So our goal right now is to try to catch lung cancer as early as possible to actually cure people.
Why is it so hard to catch it early?
MITZMAN: It doesn’t cause symptoms and that’s the problem. Lung cancer, it won’t make you cough, it doesn’t cause shortness of breath. Patients don’t know they have it until it becomes advanced, which is why we’ve developed lung cancer screening now. So patients that are smokers will get a CAT scan every single year that’s covered by insurance. It’s free. It’s like a mammogram or colonoscopy, so we could try to catch these cancers earlier.
Do the most of the people that you see with lung cancer, are they smokers or is that just a misconception?
MITZMAN: Smoking is definitely a risk factor for lung cancers, and we see a lot of patients that were smokers, but it’s not the only reason. There’s a lot of other risk factors that can lead to lung cancer, about 20% of patients that have lung cancer never touched a cigarette. So really is a misconception that only smokers get lung cancer.
Why is it so hard to see cancer in the lungs?
MITZMAN: So it is hard to see it in the lungs because you don’t really see it on an X-ray. Lung cancers will often start tiny, just a couple of millimeters and that won’t come up on a chest X-ray. Lung cancer is hard to detect because it usually starts at just a few millimeters in size and that’s when it’s not causing any symptoms. When it’s still early stage, you can’t see that on an X-ray. So patients need to have a CT scan, a CAT scan to be able to find it. And even once we find these tiny nozzles, the question is, is it a lung cancer or is it not a cancer, or It just a little scarring from an infection? So that brings us to the next step of how do we get a biopsy? How do we prove it’s a cancer?
So usually when you treat it, you would take it out with, we’ve been using the Da Vinci robot or a while, a long time now, probably, right?
MITZMAN: Not as long as you would think. So the Da Vinci robot itself has been around for 20 years, but it really hasn’t been adopted in thoracic surgery, not nationally until about 2016. And since then we’ve found such a great use for that. It’s really been skyrocketing the number of thoracic surgeons that use it. Well, you’re right. Usually if we have a diagnosed lung cancer, we go in and take it out. But again, there’s two issues before we even get to that. It’s proving that it’s a lung cancer, we don’t want to go do a lung resection on a patient that may just have a little benign scarring. And that’s when we do go into take it out, it’s finding it if it’s only two millimeters. How do we find that lung cancer and save as much good lung tissue as we can?
There was a description at the lung, when you’re looking at it, is like a sponge, can you explain that?
MITZMAN: Yeah that’s my favorite analogy. So to me, the lung is almost like a wet sponge when we’re operating on it. And if you have a small lung cancer, it’s almost like a p hidden inside this wet sponge. Very hard to feel, you may not be able to see it if it’s not on the outer edge of the lung. Some lung cancers, you have to do a larger lung resection, we have to take a big piece. But we’re finding that as new research comes out, certain kind of cancers we only have to take a very small piece of lung tissue out, really just where the cancer is. So our goal is to identify the exact spot we have to take, and again, save as much good lung tissue as we can.
Now is there a new way to identify that?
MITZMAN: There is. So we have new technology now, it’s called navigation bronchoscopy and specifically, it’s robotically assisted navigation bronchoscopy. So what that is, it’s a tiny camera that will go down the airway of the patient and go inside the patient’s lung. We’re specifically using the ion which is made by the same company that makes our surgical robot, the Da Vinci. The tip of this- of this camera is robotically controlled, so it’s flexible and we can control it and navigate out through the tiny little branches of the lung tissue. And what makes it so unique is that it uses a GPS, almost it takes the patient’s CT scan and builds us this 3D augmented GPS pathway. It tells us exactly where to go so we could get out to where there are tiny little two millimeter nodule is, we inject a little dye into it so that when we go to do the lung resection, it glows for us, it glows a bright green.
What does that mean for the patient?
MITZMAN: It means we’re saving more lung tissue. So unfortunately, with the lung, once we take a piece out, you lose that lung function. Many people can handle having a large piece of the lung out, take a lung removed, and they will still breathe exactly the same as they did before, but some people can’t. So we really want to save as much good as long as we can so that patients can have a good quality of life along with being cancer-free?
And so Rodney, he had it done. Can you tell me a little bit about him?
MITZMAN: Sure. So Rodney had a very small cancer nodule on the upper part of his right lung. It only measured about six millimeters. So again, that is really tiny, that’s less than a quarter of an inch. And in the spot where it was on his CT scan, we would never be able to see it if we went inside his chest to do the lung resection. Too small to feel, too deep to be able to see. So without this technology, we would end up having to take out a fairly large piece of his lung to make sure we got all of the cancer. But with this technology, we did that ion robotic Bronchoscopy. We used that navigation GPS and we’re able to inject this bright green dye into the nodule. And then when we use the Da Vinci to go to the lung resection, it just- it lit up for us. It glowed and we were able to take out the smallest piece where Rodney was able to save all of his good lung tissue. His breathing was exactly the same after surgery, but he still was cured of his specific cancer.
What’s the difference between using this and being able to be that precise, is it less scarring, less time in the operating room, less hospital stay?
MITZMAN: So it’s all of that, which is the great thing about this. So it’s less time in the OR because we’re not guessing, we’re not taking extra lung tissue. It could just be precise and take the small piece.
Do you have a difference of time like instead of four hours, is two hours?
MITZMAN: It’s so variable based on the lung surgery that we’re doing, but is less time in the hospital. It’s potentially one night instead of two, three or four nights if we take less lung tissue. It’s improvement on how quickly the patient can get back to their normal routine and how fast they’re breathing goes back to normal, how quickly their pain resolves. And then just ultimately it’s the long-term function, it’s saving all that good lung tissue for the patient so that they can do everything that they want to do.
Do you think this could be used for other types of cancers as well?
MITZMAN: Yeah. So we’re using it really for any cancer that spreads to the lung right now. So whether its a lung cancer sorry- so whether it’s a cancer that started in the lung, a primary lung cancer, whether it’s a cancer that started somewhere else and spread to the lungs, we’re using this, again, for two reasons, to biopsy the cancers to prove what they are, but then also to mark them to take out the smallest piece possible.
Am I missing anything? Is this offered in a lot of different hospitals or you guys are one of the first?
MITZMAN: So we are one of the first in the country to use this for the marking of tumors. A lot of hospitals are purchasing this technology and using it for the biopsies, but to use it for the precision for surgery, we are definitely the first centers to do that. But it’s growing as more people are hearing what we’re able to do with this and how much it’s helping patients, people, other surgeons are starting to use it.
Why if it was used for the biopsies, why it wasn’t just used for the surgery as well?
MITZMAN: Because most people didn’t realize that we could use it in this manner. So it was- the machine was developed for the biopsies. But we determined that can really help us for the tumor marking, the tumor identification as well.
What’s next?
MITZMAN: Sure. So where we hope that this is going is rather than every cancer having to be resected, eventually we’ll have techniques where we can use this same technology, navigate out to that tiny nudge on the inside, and then use treatment to inject right into the cancer. So whether it’s a type of medicine or using something called ablation, using heat or electricity just to zap the cancer from the inside out, so the patient doesn’t need surgery but gets the same cure rate. That’s where we’re hoping everything is going.
Will those radiation seeds be option too?
MITZMAN: People are trialing that radiation seeds have not worked as well on the lung as it has in other parts of the body.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Avery Shrader
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
