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A Brief History of General Thoracic Surgery in Northern California, Sacramento and UC Davis

Posted on May 25th, 2016 in Medical Education, Uncategorized | No Comments »

A Brief History of General Thoracic Surgery in Northern California, Sacramento and UC Davis

John R. Benfield, MD

John R. Benfield, M.D.

Professor of Surgery Emeritus

UC Davis and the David Geffen School of Medicine at UCLA

(Prepared for the Department of Surgery Grand Rounds, June 2nd 2015)

Paul C. Samson, an impressive 6’6” former football player and 1928 Olympic swimmer, was the first thoracic surgeon in the East Bay after completion of the University of Michigan’s first in the world residency that focused entirely upon Thoracic Surgery.  He became a Chairman of the American Board of Thoracic Surgery, and the first President of the Society of Thoracic Surgeons – now the world’s largest and most influential group in our specialty.  In the East Bay, Samson and his partner David Dugan, preached and implemented their conviction that it is in the best interest of patients if only certified thoracic surgeons do thoracic surgery.  In San Francisco, superb thoracic surgical leaders like Leo Eloesser, Victor Richards and others, believed thoracic surgery to be a component of general surgery.  I shall refer to them as The San Francisco School.

Paul C. Sampson, MD

Paul C. Sampson, MD

In 1978, F. William Blaisdell, of The San Francisco School, became successful and deservedly much revered as chairman of the UC Davis (UCD) Department of Surgery.   There had been no accredited program in cardiothoracic surgery at UCD for nearly a decade, when Dr. Blaisdell sent Marvin Derrick, one of his excellent general surgery residency graduates to work with me for a year with the intent that Derrick would return to UC Davis to spearhead General Thoracic Surgery.  Derrick instead, elected to complete 2 more years and to become certified by the American Board of Thoracic Surgery, and not to return to UCD.   Dr. Blaisdell, a leader of the highest caliber,  recruited me in 1988.

F. William Blaisdell, MD

F. William Blaisdell, MD

When I arrived, cardiac surgery in Sacramento was very strong, but regionally general thoracic surgery was mostly in the hands of general surgeons.  In Sacramento, the only general thoracic surgeons certified by the American Board of Surgery were the late Jack Baker, formerly at of Ohio State University, Donald Hopkins, formerly at the Mayo Clinic and M.B (Beau) O’Neill in the Kaiser Hospitals.   At UCD Medical Center, cardiac surgeons Herbert Berkoff, formerly the head of the University of Wisconsin’s Division of Cardiothoracic Surgery, and David M. Follette, formerly at UCLA, joined me at UCD Medical Center.  Baker, Hopkins, O’Neill, and cardiac surgeons like Paul Kelly, Steve Rossiter, Brad Harlan, and others welcomed us graciously.  We narrowed the gap between the community and the university.   Our newly approved residency in Thoracic Surgery attracted excellent people, including Hiran Fernando, the current professor and head of General Thoracic Surgery at Boston University, Andrea J. Carpenter the incoming president of the Southern Thoracic Surgical Association who is a professor at the University of Texas in San Antonio, and Capt. Peter Roberts the former head of the Navy’s largest and most successful program in cardiothoracic surgery who is now the Deputy Commander of the Tripler Army Hospital.

In 1964, the STS was founded to be inclusive – for cardiothoracic surgeons in the community as well as in academics.  The STS database was formed in 1989 in response to a misleading article in The New York Times about cardiac surgery results that was contrary to the interests of patients.   Paul Ebert, formerly the head of cardiothoracic surgery at UCSF, and eventually the Executive Director of the American College of Surgeons, took the initiative that led to the STS database.  The purpose was to provide patients and surgeons with accurate, risk-adjusted data about cardiac surgical outcomes.  It did not take long for Medicare, insurance companies and industry to acknowledge the STS database as exemplary in health care.  In my STS presidential address in 1996, I called for the expansion of the database to include general thoracic surgery.   I am pleased that this has become reality.

I am delighted that Dr. Cooke will discuss the STS database today.  Congratulations to him and the Division of Cardiothoracic Surgery and the Department of Surgery for their accomplishments and continuing insistence on excellence.

May 25, 2015

What is Thoracic Surgery?

Posted on December 8th, 2011 in Uncategorized | No Comments »

“What is Thoracic Surgery?” is a good question. Often times the term Thoracic Surgery is used interchangeably with Cardiothoracic Surgery, Adult Cardiac Surgery, Cardiovascular Surgery, Congenital Cardiothoracic Surgery, and General Thoracic Surgery. But for the layperson, Thoracic Surgery should be synonymous with General Thoracic Surgery.

A General Thoracic Surgeon takes care of patients with surgical diseases of the chest, generally excluding the heart and great vessels. About 80% of Thoracic Surgery involves surgery for some sort of cancer. This includes such tumors as lung cancer (which kills more people in the United States than colon, prostate and breast cancer combined), esophageal cancer, tumors of the chest wall (rib cage, sternum, etc…) and tumors of the mediastinum, or the space around the heart.

But a lot of Thoracic Surgery involves curing or helping people with disease processes that are not cancer related. This includes such procedures like thymectomy for Myasthenia Gravis, sympathectomy for hyperhidrosis or “sweaty palms”, first rib resection for thoracic outlet syndrome, myotomy for Achalasia, esophagectomy and reconstruction for end stage benign esophageal disease, plication of the diaphragm for diaphragm paralysis, resection of esophageal diverticulum, removal of cysts of the chest, lung transplantation, and providing tissue or biopsies of the lung and chest tissue to diagnose problems such as interstitial lung disease.

Much of Thoracic Surgery is now done minimally invasively by using small incisions, a thin camera and high definition monitors.  This is called Video-Assisted Thorascopic Surgery or (VATS).

A Thoracic Surgeon should always be either already board certified or in the process of being board certified by the American Board of Thoracic Surgery (ABTS). In addition to ABTS certification, many thoracic surgeons are also board certified by the American Board of Surgery (ABS). There is data that demonstrates that patients who have complex thoracic surgical disease, such as lung and esophageal cancer, have better outcomes when operated on by Thoracic Surgeons as opposed to non-Thoracic Surgeons (Birkmeyer JD et al., NEJM, 2003; Schipper PH et al., Ann Thorac Surg 2009). Also, research shows that patients may not do well after esophagectomy (removal of the esophagus) because of failure of their hospital to “rescue” them from complications (Ghaferi AA et al., Ann Surg, 2009). This fact underscores the importance that some operations should be performed by Thoracic Surgeons at high volume academic medical centers.

So what is Thoracic Surgery? Now you know!