Thoracic surgery encompasses the diagnosis, management and treatment of lung cancer and other chest diseases, including mesothelioma, chest wall growths or congenital abnormalities, mediastinal tumors, esophageal cancer, esophageal motility issues and metastatic tumors to the chest region. The Thoracic Surgery Service provides a multidisciplinary team approach that works closely with specialists in pulmonary medicine, oncology, gastroenterology, and wide-ranging support services. Our Service interacts closely with the Lung Cancer Screening Program sponsored by Mountainside Medical Center Medical Center, as well as the Thoracic Surgical Program at Hackensack University Medical Center.
The Division of Thoracic Surgery is directed by Steven D. Herman, M.D., FACS, and an internationally recognized thoracic surgeon.
From left to right: Cinnamon Ballard, Medical Secretary, Valentina Kokler, P.A., and Steven Herman, M.D., FACS
The Thoracic Surgical Service at Hackensack Meridian Mountainside Medical Center has access to the most advanced instrumentation and innovative approaches for the treatment of tumors of the chest. In addition, patients diagnosed with advanced tumors that elsewhere are often considered untreatable or inoperable often find hope with us. Many of these patients maintain or regain quality of life for extended periods; some permanently. Although surgical removal oftentimes offers the best opportunity for cure, occasionally, the solution will be a combination of other treatment modalities, sometimes with innovative surgical solutions. Our extensive experience also makes us uniquely qualified to manage less common conditions such as carcinoid and interstitial lung diseases. As your partner on this journey, we are here to help you achieve your best possible outcome.
The Thoracic Surgery Service at Mountainside Medical Center aims to improve patient care and patients' outcomes. Our approach is simple: timely, high quality care with an emphasis on you. Recent medical research (Damico, 2017) has documented that a short time interval from diagnosis to definitive treatment is critical to achieving the best cancer cure results. We understand patients diagnosed with lung cancer and other chest disorders often face complex, time-consuming testing to define the status of their disease (staging). These evaluations are essential to choosing the ideal treatment plan for the individual patient. Our team has formulated an efficient pathway—from initial consultations, necessary testing, medical clearances, directly to treatment, whether surgery or other option—in a time frame that optimizes your chances for a cure.
At Mountainside Medical Center, we are continuing to use innovative technology in new and exciting ways. Our surgical team has been active in VATS surgery since its inception, and has played a role in its development and instrumentation. With a minimally invasive Video-Assisted Thoracoscopic Surgery (VATS) approach, surgery is performed through a one inch incision guided by a tiny camera, inserted through a second small incision on the patients' side. Magnified images are projected onto a monitor and specially designed instruments are inserted to treat affected areas. VATS minimally invasive surgery is the method of choice at Mountainside Medical Center. This means smaller chest incision, shorter hospital stays, less postoperative pain, and a more rapid return to a normal life.
It has also been noted in enhanced recovery protocols involving surgery of different types that patients given significant opioid pain relief in the hospital recover slower and have increased length of stay. We at Mountainside Medical Center have designed a protocol that significantly limits and in some cases eliminates opioid postoperative medications. Utilizing ongoing infusions of numbing medications directly onto the nerves near the incision, patients experience significant pain relief without the need for epidural spinal catheters and without the negative producing side effects of opioids. Patients are mobile from the outset of their recovery from major thoracic surgery. This is utilized in both open and minimally invasive surgery. Mountainside Medical Center is one of the only hospitals, in the area, offering this unique alternative to standard pain control.
We take great pride in offering tumor biomarker analysis to all of our oncology patients. Each tumor is examined to assess the unique molecular biology to help oncologists personalize cancer therapy. Mutations are defined to steer treatment recommendations. By comparing the tumors biomarkers with data from clinical studies from thousands of the world's leading cancer researchers, we provide oncologists information about which chemotherapy and/or other treatments are likely to be most effective and which treatments are likely to be ineffective for each patient – enabling the delivery of precision medicine. This comes at no cost to you.
Mountainside Medical Center is recognized by American College of Surgeons Designated Cancer Center. As such, it meets stringent standards in the management of all cancers. Its cancer program is reviewed regularly and subject to strict evaluation by the American College of Surgeons, which oversees much of cancer care throughout the United States. We value our ability to access a full range of expert physician opinions in the form of Tumor Board. Here, we are able to review your individual case & collaborate with an elite committee of multidisciplinary specialists. We are proud of this prestigious designation and what it means: Cancer Care Second to None.
Lung cancer is one of the most commonly diagnosed cancers. It is the most deadly cancer encountered but treatments, if applied early and appropriately, can be life-saving. It can happen to anyone at any time, even non-smokers.
There are two main varieties of lung cancer, depending from which cells the cancer originates. Non-small cell lung cancer (NSCLS) is the most common type. Its treatment frequently involves surgery, which brings the best outcomes. Small Cell Lung Cancer (SCLC), on the other hand, tends to grow and spread quickly. The primary treatment for SCLC is often chemotherapy.
Treatment for lung cancer varies depending on a variety of factors, including the type of lung cancer and most importantly the stage of disease. Has it spread outside the lung to other organs? Are lymph nodes involved? How large is it? Once staged, a treatment plan that may consist of surgery, chemotherapy, targeted cancer therapy or radiation (traditional or novel approaches) is created for the patient. On occasion, combination therapy, utilizing multiple modalities is required for optimal treatment.
Radiologic and Nuclear Medicine Scans: CT scan of the chest is usually done to investigate an abnormality, symptom, or other reason and frequently is the basis of referral to a thoracic specialist. Additional radiologic studies are frequently performed to assess if an abnormality is tumor as well as, to determine the extent of the process. Some imaging that may be necessary include PET CT, MRI, CT scan and bone scan which are non-invasive.
Bronchoscopy: Performed by either a pulmonary specialty physician or thoracic surgeon. It is an examination of the trachea and bronchi (tubes leading to the lung) utilizing a camera which is passed into the airway by a flexible tube. It can be done either under local numbing analgesia or general anesthesia. Patients most often can go home the same day and hospitalization is not necessary. Samples of tissue can be obtained to make a diagnosis of a lung abnormality.
Endobronchial ultrasound (EBUS): Samples lymph glands in the chest to diagnose cancer, infections or diseases such as sarcoidosis. EBUS is performed through a bronchoscope and therefore requires no surgical incision. Ultrasound identifies target lymph nodes and allows biopsies to be done under direct ultrasound guidance.
Navigational Bronchoscopy: An innovative technology combining bronchoscopy, CT scanning and GPS concepts, allows tissue sampling of growths in the lung. This can obtain diagnostic tissue from hard to reach peripheral lung nodules or masses and is an alternative to CT guided biopsy, which involves using an invasive needle to enter the chest to biopsy a lung lesion. Navigational bronchoscopy does not require hospitalization.
CT Guided Lung Biopsy: Performed by an experienced thoracic interventional radiologist. The lung lesion is accessed by a needle placed through the chest, under local anesthesia. Patients typically go home the same day and hospitalization is not necessary.
Mediastinoscopy: This procedure accesses and samples lymph nodes adjacent to the trachea, and stages the tumor by clarifying whether nodes have cancer. It is a surgical procedure under general anesthesia, with a small incision in the lower neck. Patients typically go home the same day with no hospitalization necessary.
Lobectomy: This definitive procedure is considered the gold standard of care for lung cancer and involves removal of the lung lobe containing the tumor. Lobectomy, when feasible, has been the treatment of choice for early stage lung cancer for over 60 years and multiple medical studies have reconfirmed this is the best option for cure. This procedure has traditionally been performed via an open surgical approach. It can also be performed by minimally invasive VATS technique (Video Assisted Thoracic Surgery) although this is a more complex and technically challenging procedure. Our extensive experience with VATS technique permits safe and effective results. We offer methods that facilitate complete tumor removal, while preserving lung function and offering shorter recovery time.