2017 for the UC Davis Section of General Thoracic Surgery was a resounding success! The year saw the Section providing excellent clinical care, with outstanding outcomes for the people of California and surrounding states. The Section continued to advance the field of thoracic surgery with innovative research. Finally, through our training programs, we are developing a culturally competent thoracic surgery workforce that practices patient-centered and highest quality surgical care within the communities they serve. Below are just a few of our accomplishments:
Excellent Clinical Outcomes
Our surgeons, Section Head David Tom Cooke, MD, FACS, Lisa Brown, MD, MAS, FACS and Elizabeth David, MD, MAS, FACS performed hundreds of thoracic procedures, including surgery for lung and esophageal cancer, mesothelioma, tumors of the thymus, resection of tumor metastasis to the lung, tissue acquisition for molecular testing, hyperhidrosis (excessive sweating of the hands), and management of pleural effusions. Ours surgeons performed surgery for benign esophageal diseases like achalasia, surgical treatment of acid reflux, esophageal/stomach (paraesophageal) hernias and esophageal motility disorders. In addition, the Section offered a robust robotics and video-assisted thoracic surgery (VATS) program, where currently 70% of our pulmonary resections are performed minimally invasively, and 85% of our Stage I lung cancers. We saw over 500 new outpatient referral patients. And most patients, 73%, were seen within 14 days of their primary or specialty provider’s referral. In 2017 the Section exhibited excellent clinical outcomes as measured by the most recent national quality assurance metrics:
To provide the most complete information to our patients and help them with their clinical decision making, the Section through the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database Public Reporting program voluntarily makes public our outcomes for lung cancer surgery. We are one of only two programs in the state of California to publicly report our lung cancer surgery outcomes as measured by the STS.
Lung Cancer Screening
Partnering with the UC Davis Department of Radiology, the Section of General Thoracic Surgery leads the UC Davis Comprehensive Lung Cancer Screening Program(CLSP). The program has been designated by the American College of Radiology, and a screening center of excellence by the Lung Cancer Alliance. Dr. Brown serves as the Clinical Director, and Dr. Cooke is the Task Force Chair, facilitating a multi-disciplinary and multi-specialty team of lung cancer experts and leaders. In the past 24 months the UC Davis CLSP has screened over 550 individuals who are at the highest risk for developing lung cancer. A study is underway “Piloting Personalized Tobacco Biomarker and Radiographic Reports as Motivational Tools for Smokers to Become Smoke-free with Lung Cancer Screening”.
High Performing for Lung Cancer
For 2017-18 we have been recognized by US News & World Report as High Performing for Lung Cancer Surgery. We are the only program in the greater Sacramento area, California Central Valley, North California and Western Nevada regions so honored for every year this award has been issued.
Sacramento Magazine Top Docs
All of our surgeons, Drs. Cooke, Brown and David, have been named 2017 Top Doc by Sacramento Magazine. Top Doctors are selected by Sacramento Magazine through a survey of physician peers. The clinicians selected as Top Doctors are considered the Sacramento regions best physicians.
With help from the Hospital Consumer Assessment of Healthcare Providers and Systems we are able to measure our patients’ perspectives on their care while in the hospital. This information is publicly reported. What did our patients tell us? Ninety-one percent of our patients felt that they were treated with courtesy and respect by their doctors. The majority (76%) of our patients believed their pain was always well managed; most (95%) of our patients asserted they received adequate discharge information and were counseled by staff on who will help them when going home (95%) and what potential problems to look for (96%). We are proud that all of the above results are well above national averages.
Through the UC Davis Comprehensive Cancer Center, the Section offered leading edge clinical trials to benefit our patients. In 2017 we completed a multi-institution Phase III Randomized Trial of Lobectomy versus Sublobar Resection for Small (≤ 2 cm) Peripheral Non-small Cell Lung Cancer. This trial will tell us whether or not we really need to remove a lot of lung for very small lung cancers. Another exciting trial that we are actively enrolling patients into is the multi-institution Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST). This trial looks at the molecular profile of tumors that are removed by surgery, and then we potentially treat patients with medications specifically targeted to that molecular profile. We would like to thank all of our patients who have been screened and enrolled into our menu of clinical trials. With our patients, who are partners in our efforts to cure lung cancer, in 2017 Dr. Cooke received the UC Davis Comprehensive Cancer Center Highest Accrual Award for Surgery for 2016.
Our thoracic surgery faculty sought new information that leads us closer to our goals of improving outcomes after surgery for lung and esophageal disease. This included the implementation of an esophagectomy enhanced recovery protocol that minimized complications, mortality and hospital resource utilization; development of a surgical selection tool to identify patients with advanced lung cancer who might have curative potential with surgery; characterization of patients with lung cancer invading in to the rib cage, and data that suggest that those patients may not need postoperative chemotherapy. Below are 19 peer reviewed scientific publications for 2017 from the Section of General Thoracic Surgery:
- Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size. Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Filosso PL, Guerrera F, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, Louie BE. J Thorac Cardiovasc Surg. 2018 Jan;155(1):405-413. doi: 10.1016/j.jtcvs.2017.08.102. Epub 2017 Sep 9.
- Extent of Resection and Lymph Node Assessment for Clinical Stage T1aN0M0 Typical Carcinoid Tumors. Brown LM, Cooke DT, Jett JR, David EA. Ann Thorac Surg. 2018 Jan;105(1):207-213. doi: 10.1016/j.athoracsur.2017.07.049. Epub 2017 Nov 11.
- The Society of Thoracic Surgeons General Thoracic Surgery Database: 2017 Update on Research. Gaissert HA, Fernandez FG, Crabtree T, Burfeind WR, Allen MS, Block MI, Schipper PH, Jacobs JP, Habib RH, Shahian DM; Additional Authors. Ann Thorac Surg. 2017 Nov;104(5):1450-1455. doi: 10.1016/j.athoracsur.2017.08.060. Review.
- Perforated esophageal intervention focus (PERF) study: a multi-center examination of contemporary treatment. Ali JT, Rice RD, David EA, Spicer JD, Dubose JJ, Bonavina L, Siboni S, O’Callaghan TA, Luo-Owen X, Harrison S, Ball CG, Bini J, Vercruysse GA, Skarupa D, Miller Iii CC, Estrera AL, Khalil KG. Dis Esophagus. 2017 Nov 1;30(11):1-8. doi: 10.1093/dote/dox093.
- Special issue on complex aerodigestive endoscopy. Cooke DT. J Vis Surg. 2017 Sep 30;3:134. doi: 10.21037/jovs.2017.08.09. eCollection 2017. No abstract available.
- Adjuvant Chemotherapy Does Not Improve Survival for Lung Cancer With Chest Wall Invasion. Brown LM, Cooke DT, David EA. Ann Thorac Surg. 2017 Dec;104(6):1798-1804. doi: 10.1016/j.athoracsur.2017.06.070. Epub 2017 Nov 1.
- A Model to Predict the Use of Surgical Resection for Advanced-Stage Non-Small Cell Lung Cancer Patients. David EA, Andersen SW, Beckett LA, Melnikow J, Kelly K, Cooke DT, Brown LM, Canter RJ. Ann Thorac Surg. 2017 Nov;104(5):1665-1672. doi: 10.1016/j.athoracsur.2017.05.071. Epub 2017 Sep 28.
- The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non-Small Cell Lung Cancer. David EA, Clark JM, Cooke DT, Melnikow J, Kelly K, Canter RJ. J Thorac Oncol. 2017 Nov;12(11):1636-1645. doi: 10.1016/j.jtho.2017.08.008. Epub 2017 Aug 24. Review.
- A Model for Military-Civilian Collaboration in Academic Surgery Beyond Trauma Care. Anderson JE, David EA, Loge HB, Farmer DL, Galante JM. JAMA Surg. 2017 Sep 1;152(9):891-893. doi: 10.1001/jamasurg.2017.1575. No abstract available.
- A Defined Esophagectomy Perioperative Clinical Care Process Can Improve Outcomes and Costs. Cooke DT, Calhoun RF, Kuderer V, David EA. Am Surg. 2017 Jan 1;83(1):103-111.
- Increasing Rates of No Treatment in Advanced-Stage Non-Small Cell Lung Cancer Patients: A Propensity-Matched Analysis. David EA, Daly ME, Li CS, Chiu CL, Cooke DT, Brown LM, Melnikow J, Kelly K, Canter RJ. J Thorac Oncol. 2017 Mar;12(3):437-445. doi: 10.1016/j.jtho.2016.11.2221. Epub 2017 Jan 18.
- External Validation of a Prognostic Model of Survival for Resected Typical Bronchial Carcinoids. Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, Louie BE. Ann Thorac Surg. 2017 Oct;104(4):1215-1220. doi: 10.1016/j.athoracsur.2017.05.019. Epub 2017 Aug 16.
- The devil is in the detail. Brown LM. J Thorac Cardiovasc Surg. 2017 Jul;154(1):369. doi: 10.1016/j.jtcvs.2017.03.030. Epub 2017 Mar 18. No abstract available.
- Reviewing scientific manuscripts: A comprehensive guide for peer reviewers. Brown LM, David EA, Karamlou T, Nason KS. J Thorac Cardiovasc Surg. 2017 Jun;153(6):1609-1614. doi: 10.1016/j.jtcvs.2016.12.067. Epub 2017 Feb 16. No abstract available.
- Reviewing Scientific Manuscripts: A Comprehensive Guide for Peer Reviewers. Brown LM, David EA, Karamlou T, Nason KS. Ann Thorac Surg. 2017 May;103(5):1365-1370. doi: 10.1016/j.athoracsur.2017.02.015. Epub 2017 Mar 30. No abstract available.
- Lung resection is safe and feasible among stage IV cancer patients: An American College of Surgeons National Surgical Quality Improvement Program analysis. Bateni SB, David EA, Bold RJ, Cooke DT, Meyers FJ, Canter RJ. Surgery. 2017 May;161(5):1307-1314. doi: 10.1016/j.surg.2016.11.002. Epub 2016 Dec 20.
- Is there a role for traditional nuclear medicine imaging in the management of pulmonary carcinoid tumours? Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, Louie BE. Eur J Cardiothorac Surg. 2017 May 1;51(5):874-879. doi: 10.1093/ejcts/ezw422.
- Robot-Assisted Total Thymectomy: How I Teach It. Brown LM, Louie BE. Ann Thorac Surg. 2017 Feb;103(2):369-372. doi: 10.1016/j.athoracsur.2016.11.058. No abstract available.
- Does Lymph Node Count Influence Survival in Surgically Resected Non-Small Cell Lung Cancer? David EA, Cooke DT, Chen Y, Nijar K, Canter RJ, Cress RD. Ann Thorac Surg. 2017 Jan;103(1):226-235. doi: 10.1016/j.athoracsur.2016.05.018. Epub 2016 Jul 26.
In 2017, Dr. Cooke completed his Patient-Centered Outcomes Research Institute (POCRI) Pipeline to Proposal Tier III funded work entitled “Empowering Patients and Their Families to Improve Outcomes That Are Most Important to Them after Surgery and Other Therapies for Lung Cancer”. By developing a UC Davis Community Stakeholder Advisory Panel, consisting of patients, clinicians, nursing, social work and lung cancer advocates, and combining with novel use of social media for public medical communication (lcsmchat.com), we identified patient reported outcomes to address, and information that will serve as foundations for prospective trials and investigative studies.
Dr. David received the UC Davis Comprehensive Cancer Center Paul Calabresi Clinical Oncology K12 Award. This NIH-NCI funded program combines key didactic, research, and career development components to train independent and productive clinical oncology researchers. Her project is entitled: Understanding Decision-Making for Surgery in Advanced Stage Non-small Cell Lung Cancer Patients.
Dr. Brown won the 2017 Thoracic Surgery Foundation/Women in Thoracic Surgery Carolyn E. Reed Traveling Fellowship. This annual award provided and administered by Thoracic Surgery Foundation, allows clinically established women cardiothoracic surgery academics to travel to another institution for the purpose of learning a new skill or technology. Dr. Brown traveled to the University of Michigan to work with Dr. Amir Ghaferi and learn a research methodology. Dr. Ghaferi is a leading surgical outcomes researcher, and helped to introduce the concept of “Failure to Rescue” to surgical research. This is the second year in a row that a member of the UC Davis Section of General Thoracic Surgery has won this award. Dr. Elizabeth David won the 2016 Carolyn E. Reed Traveling Fellowship.
We are honored to provide the foundation for our Cardiothoracic Surgery Residency graduates to be leaders and innovators. Our current residents hail from all across the country, and are carrying on the great traditions of our alumni. We are proud of the way the program has continued to evolve and excel. As a 2017 update:
- Dr. David Penner, graduated and entered a community based thoracic surgery practice in Reno, NV, providing much needed general thoracic surgery expertise for that community
- Dr. Anna Xue, post-graduate year 1 (PGY1) and our newest Integrative 6-Year resident, comes to us from the University of Washington School of Medicine
- Dr. Amir Sarkeshik, PGY2, received the 2017 Society of Thoracic Surgeons Advocacy Scholarship
- Dr. Melissa Blaker, PGY3, was honored with the U.S. Army Commendation Medal
- Dr. Luis Godoy, PGY4, was awarded the 2017 Outstanding Resident Teaching Award by the UC Davis Medical Student Class of 2017
Dr. David Penner, ‘17, and the General Thoracic Surgery Team at his graduation dinner
On Tuesday, February 21st we welcomed Dr. Ara A. Vaporciyan, MD, FACS, MHPE as the 2017 John Mott Jr. Visiting Lecturer. Dr. Vaporciyan is a Professor of Surgery and Chairman of the Department of Thoracic and Cardiovascular Surgery at the University of Texas M. D. Anderson Cancer Center in Houston Texas. Dr. Vaporciyan presented grand rounds, entitled: “Modernizing Pedagogy in Cardiothoracic Surgical Training”. In addition to dinner with the CT Surgery division and the Department of Surgery education division, Dr. Vaporciyan met with the residents for a discussion on career development, and the current state of cardiothoracic surgical education.
Starting from left guest Dr. Don Hopkins, Dr, Lisa Brown, Dr. Elizabeth David, Dr. Ara Vaporciyan, Dr. David Tom Cooke
In 2017, our faculty continued to provide outstanding mentorship to our trainees to maximize their professional development and success.
The Society of Thoracic Surgeons (STS) recently awarded the Looking to the Future (LTTF) Scholarship to UC Davis medical student Sarah Chen. Through a challenging selection process of 87 extremely qualified applicants, Sarah was one of 30 selected recipients for this award. They will be present in the upcoming STS 54th Annual Meeting in January 2018 at Ft. Lauderdale, Florida.
Advocacy for Thoracic Disease
In 2017, our entire faculty assisted advocacy groups in community efforts to battle lung and esophageal cancer.
Dr. Cooke served on the Medical Advisory Committee of the Esophageal Cancer Education Foundation. In addition, Dr. Cooke continued on the American Lung Association (ALA) Lung Cancer Expert Medical Advisory Panel as well as the organization’s National Volunteer Media Spokesperson. Also, Dr. Cooke severed on the Governing Board of Directors of ALA in California, and helped lead the fight to enact California Proposition 56, which came into law on April 1, 2017. Proposition 56 increased the cigarette tax by $2.00 per pack, with equivalent increases on other tobacco products and electronic cigarettes containing nicotine. The bulk of new revenue is earmarked for Medi-Cal (Medicaid), to benefit the healthcare of low income Californians.
Dr. Brown became one of the newest members of the Scientific and Medical Editorial Review Panel for the American Lung Association. She joined the current panel of experts in reviewing scientific and medical content on Lung.org to ensure the most accurate and up-to-date lung health information is available for the public.
Dr. David took part in the first annual American Cancer Society National Lung Cancer Roundtable held on December 11, 2017 in Bethesda, Md. The National Lung Cancer Roundtable is a nascent nationwide coalition of organizations committed to addressing the challenges of moving lung cancer screening into the mainstream.
Thank You to Our Supporters!
Finally, we offer a heartfelt thank you to all of our grateful patients, alumni, colleagues, and UC Davis employees and staff who offered their donations and support that allow us to continue our dedicated service to the people of the Sacramento region, Central Valley and the State of California. To learn more about how to support our Section of General Thoracic Surgery, click here; and how to support our Cardiothoracic Surgery Residency Program, click here.