Joey Wahler (Host): It's a game changing treatment, so we're discussing robotic lung cancer surgery. Our guest is Dr. Gavin Henry. He's medical director of the Tate Cancer Center. Also chair of Thoracic Surgery at University of Maryland, Baltimore Washington Medical Center. This is the live greater podcast series, information for a Healthier You from the University of Maryland Medical System.

Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Henry. Welcome.

Dr Gavin Henry: Happy. Hi, how are you?

Joey Wahler (Host): Great. Yourself.

Dr Gavin Henry: Great. Great.

Joey Wahler (Host): Excellent. So we're off to eight. Great start. We appreciate the time first Maryland, as you well know, ranks among the top states in the nation for lung cancer surgery as a first course of treatment. So what does that say, do you think about how lung cancer is being detected and treated here, and why is early detection so important in this instance?

Dr Gavin Henry: Well, I, think the state of Maryland has, a lot of. High quality care in regards to hospitals in there. And, they put a big emphasis on lung cancer screening and, therefore our early detection. I think this has also helped with the increased rate for our surgical, patients and surgical treatments.

and it's really been a game changer over the last few years in regards to the lung cancer screening.

Joey Wahler (Host): When we talk about early detection in this case, tell people why that's so crucial.

Dr Gavin Henry: Well, first of all, for lung cancer, it is so important to pick it up very early. stage one or stage two, the prognosis can be very, very good. So early detection is very, very important. And so this is where lung cancer screening comes in. Just like with the other type of cancers that we deal with, colon, breast, prostate, you want to screen early because the earlier to detected it, the prognosis is better, and you can get to surgery a lot sooner.

Joey Wahler (Host): So that being said, give people an idea, please. Of what lung cancer screening involves, how often you should get it, et cetera.

Dr Gavin Henry: Well, there is a protocol or there is a guidelines. the typical patient is anywhere between the ages of 50 to 80, and this is the guidelines, 50 to 80, smoke for more than 20 years, or we say 20 pack years. So if you take. One pack, they multiply by 20.

We call that 20 pack years. And that's the guideline for screening. typically. What we've seen in the past, the rate of screening was relatively low, not only in the state of Maryland, but throughout the country. If you go back around 2010, the screening rates were like around three or 4%, which is pretty, abysmal.

we got it now up to maybe about 16 to 20%, and that's still pretty low, but we are making progress. But low dose screening CT scans are very, very simple. it only gives up about 20% of the normal radiation, of the normal scanning, so that's good. And literally it only takes probably less than 10 to 15 minutes for the CT scan.

And so, we've made, significant progress in regards to the imaging studies over the last decade or so.

Joey Wahler (Host): Okay, so some good news on that front there. And by the way, there have been other live greater podcasts previously that discuss screenings in more detail. For those joining us. That would like to check those out as well. Now, for those joining us that may not be familiar, what exactly doctor is robotic surgery and how is it different from traditional surgery for lung cancer?

We should point out first that no robots have not taken over the operating room. There are still experts like yourself that are human, whose hands are behind the whole thing, right?

Dr Gavin Henry: Yes, that is correct. traditional surgery is what we call open surgery or open tho economies. The incision may be anywhere between 10 to 12 inches in size. It's a pretty large incision. but for thoracic surgery we've started doing more minimally invasive surgery. And robotic surgery is, a type of minimally invasive surgery.

And the advantages for us is that we are able to have smaller instruments. The magnification on the vision is a lot higher. We have a lot less blood loss, but it does use the robot. The robot is just a tool. It just helps us, To get better vision and also, better, tools, within, the platform

Joey Wahler (Host): And so that being said, what are the benefits of this for patients?

Dr Gavin Henry: for patients. over a period of time since I've been personally donating, we've had decreased length of stay, we may cut about a half a day to a day off your length of stay in the hospital, decreased in blood loss. Decrease in pain, are really the biggest ones that we've definitely seen over this period of time.

Joey Wahler (Host): Of course, as you well know, robotic surgery has now touched just about every branch of surgery. It seems we hear a lot of those that perform it like yourself, talking about how much more precise it enables you to be when operating. Why is that so important in this case?

Dr Gavin Henry: Well, from a thoracic surgery standpoint, in the chest, we are around some major blood vessels, that attach to the heart. and that's very important for us to be precise and have precision around those blood vessels. also too, when we have to do dissections and we take lymph nodes out, we want to be precise also in order to get those.

And we also can do more intense surgeries or more complicated surgeries because of the precision, of the robot, which otherwise, in other many invasive forms or even the open form will be a little more challenging for the surgeon. The robot allows us to have increased magnification and also to the instruments gives us more degrees of articulation of our wrist or fingers that we would not otherwise have.

Joey Wahler (Host): It's really pretty amazing, isn't it?

Dr Gavin Henry: Yeah. it's amazing. It's made my job a little bit easier.

Joey Wahler (Host): I'm sure it has. So how do you go about deciding whether a patient is a good candidate for robotic surgery and how much of a factor, for instance, is the particular cancer stage of a patient?

Dr Gavin Henry: I think with most thoracic surgeons now, I think most people will try to see if they can do almost every patient, mainly invasive or robotic if they can. So when you come into my practice, we're gonna try to do your robotic, unless otherwise, unless there's a reason we can't.

and those reasons could be a variety of reasons. Be location of tumor, size of tumor, if a patient's had prior surgeries in his chest. But for most part, I would say over 90% of our patients are done robotically. and there are multiple decision factors, but, usually most of our patients We plan on doing robotically.

Joey Wahler (Host): Gotcha. Great to know that. But how about patients diagnosed at a later stage? Can surgery still be an option for them in some cases?

Dr Gavin Henry: Yeah. Even though most of our patients we do receive, our early stage, some that are later stage. They obviously have a little bit more of a intense treatment. They may get chemotherapy, they may get immunotherapy or radiation or all three. And in a certain subset of patients, those patients still may be able to get to surgery and we still may also be able to do it robotically too.

although there are smaller in regards to percentages, but yes, that it's still possible too.

Joey Wahler (Host): So in terms of the actual patient experience, what can people expect before as they prep during the procedure and after in terms of recovery?

Dr Gavin Henry: Well, from a prep standpoint, most of patients, when they come into the office, it's more explaining. Their diagnosis. and then of course we'll go into details about the surgery and, what that means and where the incisions, will be on the chest. most of the incisions about three to four incisions, about a third of an inch in size, and we work in between the ribs, roughly right under the shoulder blade.

And so we describe this to patients, pre-op. most patients always want to know, what do I have to do to get ready for surgery? the biggest thing is, walking and, being active. That also helps 'cause those are the, some of the things that we expect them to do afterwards.

And of course, if those patients are smoking, we try to hopefully ask them to decrease their smoking or stop if they can't, during surgery or pre-op while they're in the hospital, we see them again and they, actually, when they make it into the operating room, some patients really wanna see the robot.

They want to see. it looks like. And, and of course everyone has different impressions and, they want to name it and so forth. So they also kind of get involved in some of the robotic, jokes that we have. And then post-op, it's just like any other minimally invasive surgery.

It's pretty standard. most patients will stay in the hospital anywhere between two to three days. And when they get home, we don't really have a lot of restrictions, just no heavy lifting, but they can be very active. They can do stairs, they can shower, they can go to the store.

really within the first two weeks. And by two weeks out, most patients have already driven themselves to their post-op visit. and they're recovering pretty quickly.

Joey Wahler (Host): Well, that's certainly comforting news. I'm sure. Now a couple of other things. Robotic surgery is really part of a team approach to lung cancer care, right? So how would you say it compares with the other treatments? People are maybe more accustomed to hearing about radiation, chemotherapy or even immunotherapy.

Dr Gavin Henry: here at, Baltimore, Washington Medical Center, we have, what we call tumor board, and we have different types of tumor boards. Depending upon the area for thoracic, which is the chest, we have a thoracic tumor board where you have the medical oncologist, radiation oncologist, the pulmonologist, and of course the surgeon.

And so collectively, we. Make a plan for their patient. do they need to get biopsy? Do they need chemo? Do they need immunotherapy or radiation prior or, or do they just go straight to surgery? So everyone, pretty much is evaluated, by the whole set of, healthcare providers. and it is just very similar to the other service line.

and we at that time can decide if this patient's gonna be a robotic candidate. We can decide if the patient is gonna end up, need a biopsy or needing chemotherapy before, or immunotherapy before. So a lot of those decisions are made behind the scenes. Sometimes even before the patient has actually seen me.

we have at least an idea or sometimes it could be after. Also, they've been seen.

Joey Wahler (Host): And it sounds like that's really important here, right, doctor? Because I would imagine sometimes one of the first things people. Will ask you as a patient, if you suggest the robotic approach is, well, how do I know that I might not be better at going one of these other routes?

And you can tell them, well, we've already weighed in with those experts as well, and here's what they think too. Right?

Dr Gavin Henry: Yeah, and I think that's important. today is, for the patient to be informed, of all their different choices. cause surgery is not only the only choice. It course is choices for other treatments, but, to have the patient understand that it's been discussed. But in, even in those cases, we also, if they like.

To have a consultation with the other service lines such as medical oncology, radiation oncology, or whoever it may be, to make sure that they have those consultants, see them and also too, so that they're well informed so they can understand the decision making process. So information is power, information is king, for the patients.

And so for most part, most patients understand once they're informed, for them, the decision ends up not being too much of an issue.

Joey Wahler (Host): Absolutely. And in summary here, doc, you've done a great job of breaking down some of the details. Overall, what's your message for those joining us regarding how innovations in robotic surgery have really changed the lung cancer outlook for patients and families? What does it really all boil down to in terms of what it means for them?

Dr Gavin Henry: Well, it's definitely not the grandfather's surgery, that's for sure. Most patients would say, oh, my grandfather or father had this big surgery and they had a huge incision, and they stay in the hospital for two weeks. No, that's no longer the case. Uh, now we can get patients in and out two to three days, sometimes even one day overnight for a major lung resection.

And I think that's important, for them to know that that. Times have changed. Early detection has made a big difference in regards to the screening. Our ability to biopsy smaller nodules to make the diagnosis at earlier stage. And then of course to get you to the robotic lung resection.

all those have changed significantly over the last decade or so. Um, and this allows patients to get back to work, get back to their life a lot, quicker than it ever has been before.

Joey Wahler (Host): You're reminding me with what you mentioned a moment ago saying this is not your grandfather's surgery. Uh, years ago there was that commercial. This is not your grandfather's Oldsmobile. So kind of the same thing, right.

Dr Gavin Henry: Yeah. Yeah.

Joey Wahler (Host): Well folks, we trust you are now more familiar with robotic lung cancer surgery. Dr. Henry, it sounds like really just, uh, amazing stuff as we touched on earlier. Keep up all your great work and thanks so much again.

Dr Gavin Henry: Thank you very much for having me.

Joey Wahler (Host): Absolutely, and you can listen to more podcasts just like this one at ums.org/podcast on YouTube or on your favorite podcast platform. Now, if you found this episode helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Live Greater Health and Wellness Podcast, brought to you by the University of Maryland Medical System.

We look forward to you joining us again.