Video-Assisted Thoracoscopic Surgery (VATS) Helps a Patient Live the Life She Wants

Advanced Lung Surgery Lets Nancy Smith Enjoy Active Lifestyle

Nancy Smith was pretty sure she had found the right surgeon when her oldest daughter looked at his picture and said, “Mom, look at those gentle eyes.” A Virginia Mason patient since the 1950s, Nancy knew she had the right hospital. It was a diagnosis of possible lung cancer that prompted her to look for a surgeon.

Nancy Smith

Nancy Smith and her dog.

In January 2010, Virginia Mason surgeon Donald Low, MD, FACS, removed a cancerous lobe from Nancy’s right lung. Nancy never felt sick or different; it was a routine X-ray that revealed the suspicious spots. Nancy underwent a limited thoracotomy, an open lung procedure that would give Dr. Low the best access to the area of suspected cancer without damage from spreading or cutting the ribs. First, a wedge of tissue was retrieved and immediately sent to pathology. The diagnosis was squamous cell carcinoma, a slow growing but potentially invasive form of lung cancer.

Choosing an open procedure meant Dr. Low could thoroughly examine the tumor area. Three separate areas of cancer were identified within a single lobe of Nancy’s lung. The decision was made that a lobectomy, with the removal of thoracic lymph glands, would be the best cancer surgery for Nancy. Removing just one of the three lobes in Nancy’s lung preserved much of her lung function while eliminating all detectable disease.

Nancy’s oncologist suggested following up surgery with chemotherapy, as an extra weapon against the cancer returning, but Nancy declined. The fact that Nancy’s lymph glands had tested negative for cancer only strengthened her resolve. She considered the possible benefit — a 5 to 10 percent reduction in risk of recurrence — but that didn’t outweigh her desire to keep feeling like herself.

“I said no a lot, and Dr. Low totally understood,” says Nancy. “You can be really honest with him and he respects every bit of it. I take life as it’s given to me. I want to live well while I can.” Nancy also said no to a lifelong smoking habit following her successful surgery and never looked back.

Hospital stays following procedures like Nancy’s average up to nine days nationally, but she was ready to go home on day four. Nancy credits Dr. Low’s care for getting her back to her full life in Bellingham, Wash., maintaining her three-level home — “I do all my own everything,” she says — and enjoying her four daughters and grandchildren. But nearly two years after Nancy’s lung surgery, her regular CT scans showed a new nodule in her left lung.

The single nodule wasn’t like the tiny scattered spots she had before, so this time Nancy was a candidate for a minimally invasive procedure. Video-assisted thoracic surgery, or VATS, is only available in highly specialized surgical centers, like the one in Virginia Mason’s Lung Cancer Program. VATS allows the surgeon to operate on the lungs through small incisions, guided by a slender camera that produces images from inside the body on a video monitor. Patients who undergo VATS typically have a much shorter hospital stay, need less pain medication and recover faster with less scarring.

Nancy’s VATS procedure was a success, removing a wedge of lung tissue around the nodule diagnosed as stage I adenocarcinoma, a totally separate cancer from her first diagnosis. The early stage meant the cancer was localized, a good reason to preserve Nancy’s lung function by performing a wedge resection and not a second lobectomy. After surgery, Nancy came to a consensus with her care team that regular monitoring with CT scans was a plan they could all get behind.

“I was so well taken care of I perked right back up after surgery,” says Nancy, who at age 77 continues to surpass expected outcomes. Instead of agreeing to a December follow-up appointment, she told her care team she was going on vacation and she’d see them in February. The fact was Nancy felt terrific, and only noticed a difference in her breathing when going up and down stairs or walking fast. “What I know is he’s a really caring doctor who will sit and talk with you,” says Nancy about Dr. Low. “I trust him with my life and my daughters feel the same way. He’s top of the line.”

***

Jennifer Sorenson wrote this story for the Virginia Mason 2012 Annual Report.

Comments

  1. Glad everything turned out well for Nancy. At her age she’s still have a lot of courage to fight back with her disease. Today, significant advancement in the approach and technology have exceedingly enhanced the surgical outcome and quality of life for those patient going through this procedure. Kudos to Dr. Low and the medical team who were able to help extend the life of a patient and for giving Nancy a positive experience on her days at the hospital.

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