Cardiothoracic Surgery (Thoracic Surgery)

An esophagectomy is a surgical procedure to remove part of the esophagus. Nearby lymph nodes and a small part of the stomach may be removed as well. The remaining stomach is then pulled up to connect to the upper section of the esophagus.

Surgical removal of the esophagus has traditionally required a thoracotomy (an incision in the chest), as well as a laparotomy (abdominal incision). These incisions offer maximal exposure for the surgeon, but can cause significant postoperative pain and lung complications, including pneumonia.

Minimally invasive surgical options offered at Weill Cornell Medicine

At Weill Cornell Medicine, we strive to use minimally invasive surgical approaches—such as laparoscopy or video-assisted thoracoscopy—for patients with operable esophageal cancer (early esophageal cancer or dysplasia). During these procedures, telescopes placed through small incisions in the chest and abdomen are used to visualize, manipulate, and remove the esophagus and surrounding lymph nodes.

Minimally invasive surgery to remove the esophagus typically requires a shorter stay in the hospital compared to conventional open surgery. Also, patients who have minimally invasive esophagectomy typically experience less discomfort, require fewer pain medications, and recover more quickly.

Why choose Weill Cornell Medicine for esophageal surgery?

Our patients benefit from:

• The most advanced techniques in surgical procedures including robotics, which enables greater magnification and more precision

• Our excellent network of medical professionals—including oncologists, gastroenterologists, and pathologists—working with our thoracic surgeons to ensure patients receive truly comprehensive care

• Treatments tailored specifically to our individual patients

• Our record of excellent outcomes—among the best in the nation—with very low rate of complications

• Expertise in operating on patients with other health problems (such as diabetes, kidney problems, or others) and those who are elderly

Interventional Pulmonology is a relatively new subspecialty within Pulmonary Medicine that uses advanced procedures to diagnosis and treat patients with various lung diseases. It is a minimally invasive approach that replaces many procedures that previously required surgery.

Endoscopic procedures offered at Weill Cornell Medicine

An endoscope is a small, flexible tube with a camera and light attached to it. This tube can be passed through a patient’s airways in order to view the different sections of the chest cavity and lungs. Much of interventional pulmonology is endoscopic.

Small tools can also be utilized through the endoscope to perform minor procedures such as a biopsy or bronchial stent (opening an airway tube), and some larger procedures such as locating and treating certain tumors.

Weill Cornell offers the latest technological approaches in interventional pulmonology:

• Navigational bronchoscopy is used to locate, biopsy, and possibly treat some hard-to-reach lung tumors. This procedure combines electromagnetic navigational techniques with 3D computed tomography images to guide the endoscope more accurately than a traditional endoscope.

• Endobronchial ultrasound is used to more precisely identify and biopsy central lymph nodes in the chest to examine them for cancer cells.

Both of these procedures spare patients from more invasive approaches, and they can be done on an outpatient basis.

Why choose Weill Cornell Medicine?

Our patients benefit from:

• Physicians with specialized training in diagnosing, treating, and managing typical pulmonary conditions—as well as highly complex and rare disorders

• Diagnostic and therapeutic therapies at the forefront of today’s medical knowledge

• Our excellent network of medical professionals – including oncologists, thoracic surgeons, and pathologists – working with our interventional pulmonologists to ensure patients receive truly comprehensive care

• Treatments tailored specifically to our individual patients

Surgery to remove tumorous tissue is the most effective treatment for early stage non-small cell lung cancer (NSCLC). The procedure may involve removing a section of a lung or an entire lung, depending on the size and location of a tumor.

Until recently, the standard approach for the surgical treatment for lung cancer was “open surgery,” which included a large incision that spreads the ribs (thoracotomy). This technique is associated with postoperative pain and lung complications, including pneumonia.

Minimally invasive surgical options

At Weill Cornell, we use minimally invasive surgical approaches in 90% of patients—such as video-assisted thoracoscopy (VATS) or robotic techniques—for patients with operable lung cancer.

Thoracoscopic lobectomy (VATS): Telescopes placed through small incisions in the chest and abdomen are used to visualize the lung, and small instruments are passed between the rib spaces to manipulate and remove the lobe.

After a thoracoscopic lobectomy, most patients need to stay in the hospital for only two to three days. They typically achieve improved breathing function earlier than they would have following open surgery, as a result of this less invasive and less painful procedure. Patients who have thoracoscopic lobectomy also usually require fewer pain medications than those who have traditional, “open” surgery.

Lung cancer surgery expertise at Weill Cornell Medicine

Our patients benefit from:

• The most advanced techniques in surgical procedures including robotics, which enables greater magnification and more precision

• Access to state of the art genetic testing of patient tumor to determine best approach for further treatment if necessary

• Access to the latest clinical trials for all stages of cancer condition

• Multi-disciplinary approach (collaboration among surgeons, oncologists, radiologists, gastroenterologists, and pathologists) tailored to the unique needs of each patient

Achalasia affects the muscle of the esophagus. This disorder causes the band separating the stomach from the esophagus to spasm, which can prevent food from reaching the stomach normally. Currently, it is not known what factors cause achalasia.

Patients suffering from achalasia usually complain of intermittent regurgitation (food coming back up into the esophagus from the stomach) and food feeling like it is "sticking" in the esophagus after swallowing.

Expert achalasia treatment at Weill Cornell Medicine

Diagnosis: Achalasia is diagnosed using tests that examine the structure and function of the esophagus. These tests can include:

• Barium swallow: Patients swallow a liquid that will be visible on an X-ray. A series of X-rays are then taken. People with achalasia will often demonstrate abnormal valve relaxation and an absence of normal contractions.

• Esophageal manometry: Pressure in the valve between the esophagus and stomach is measured using a small catheter placed into the esophagus. Patients with achalasia typically have an elevated lower valve pressure and experience failure of the valve to relax when they are swallowing.

• Endoscopy: During this procedure, a small, flexible telescope is passed through the mouth into the esophagus to examine the esophagus.

Treatment: Achalasia can be complex to treat. It is important to seek expert care for this condition.

Medications that relieve the spasm are typically ineffective and can cause numerous side effects. A procedure called “endoscopic balloon dilation” achieves good results in up to 60 percent of patients, but the benefits often do not last. There is also a risk of perforating the esophagus during dilatation, which requires emergency surgery.

Traditional, “open” surgery for achalasia requires a rib-spreading incision to perform an esophageal "myotomy," or splitting of the abnormally thickened esophageal valve. This carries risks of infection and other complications as well as longer recovery periods.

Minimally invasive achalasia treatment: Weill Cornell thoracic surgeons are able to employ a minimally invasive laparoscopic approach to myotomy in most of our achalasia patients.

After laparoscopic myotomy, patients typically stay in the hospital for only two days, they experience minimal postoperative discomfort, and they are able to eat regular food by the time they are ready to leave the hospital.

Why choose Weill Cornell Medicine for achalasia treatment?

Our patients benefit from:

• The most advanced surgical techniques available today

• Our excellent network of medical professionals, including oncologists, gastroenterologists, and pathologists, working with our thoracic surgeons to ensure patients receive truly comprehensive care

• Treatments tailored specifically to our individual patients

• Our record of excellent outcomes — among the best in the nation — with very low rate of complications

• Expertise in operating on patients with other health problems (such as diabetes, kidney problems, or others) and those who are elderly

Gastroesophageal reflux disease (GERD) is a disorder that affects the lower esophageal sphincter, a muscular valve that separates the stomach from the esophagus. This valve normally prevents food in the stomach from regurgitating back up into the esophagus.

Patients with GERD have a weakened sphincter that allows stomach acid to flow back into the esophagus. The esophageal lining becomes inflamed and patients experience heartburn, chest pain, and sometimes a sour taste in the mouth. If left untreated, GERD can lead to ulcer formation, bleeding, and scarring.

GERD is most commonly managed by medication and lifestyle changes, such as weight loss and diet modification. When these approaches are not effective for controlling a patient's GERD, surgery may be indicated.

GERD expertise at Weill Cornell Medicine

Thoracic surgeons at NewYork-Presbyterian Hospital/Weill Cornell Medical Center perform a minimally invasive procedure called "laparoscopic Nissen fundoplication" to treat patients with GERD. During this procedure, the weakened lower esophageal sphincter is supported by wrapping the top portion of the stomach around the lower esophagus as a bolster.

Patients undergoing the laparoscopic approach experience less pain and scarring than those who have a traditional, “open” surgery. Most patients begin to eat the morning after surgery and can leave the hospital within 48 hours.

Why choose Weill Cornell Medicine for GERD treatment?

Our patients benefit from:

• The most advanced techniques in surgical procedures

• Our excellent network of medical professionals, including oncologists, gastroenterologists, and pathologists, working with our thoracic surgeons to ensure patients receive truly comprehensive care

• Treatments tailored specifically to our individual patients

• Our record of excellent outcomes — among the best in the nation — with a very low rate of complications

• Expertise in operating on patients with other health problems (such as diabetes, kidney problems, or others) and those who are elderly

Hyperhidrosis, or over perspiration, is caused by excessive secretion of the sweat glands. This disorder affects a small but significant proportion of young people all over the world. The cause of the sweating is believed to be over stimulation of the sympathetic nerves that supply the offending sweat glands.

Hyperhidrosis is often an uncomfortable or even debilitating condition: patients suffer from social embarrassment at work or school associated with excessive hand, underarm, or facial sweating. Simple tasks such as shaking someone's hands or reading a book can cause embarrassment or anxiety.

Medical therapies can help some patients with hyperhidrosis, but their benefits are temporary.

Expert hyperhidrosis treatment at Weill Cornell Medicine

Thoracic surgeons at NewYork-Presbyterian Hospital/Weill Cornell Medical Center are able to successfully treat hyperhidrosis in a minimally invasive procedure called "endoscopic thoracic sympathectomy (ETS)," which permanently relieves the nerve overstimulation that causes hyperhidrosis.

The ETS procedure takes about 15 minutes, and both sides of the body are completed in the operation. Patients are usually able to leave the hospital a few hours later. Most patients return to work and their daily activities within a week.

Our surgeons have improved the quality of lives of many patients suffering from hyperhidrosis. Ordinary social interactions such as hand shaking are no longer embarrassing or anxiety provoking.

Types of hyperhidrosis treated

• Palmar: Palmar (hand) sweating is the most common complaint in patients with hyperhidrosis.

• Plantar: Some patients experience plantar (feet) sweating alone or in addition to palmar hyperhidrosis.

• Axillary: For excessive sweating in the axillae (underarms), ETS may be considered when medical therapies (Drysol, Drionics®, beta-blockers, Botox® injections, and anticholinergic drugs) fail to relieve symptoms.

• Facial Blushing: Some patients have embarrassing blushing of the face and neck during stressful social situations. Patients with facial blushing may benefit from ETS, though there is greater risk of experiencing sweating elsewhere in the body after ETS than there is for patients who undergo ETS for palmar and axillary sweating.

Why choose Weill Cornell Medicine for hyperhidrosis treatment?

Our patients benefit from:

• Over excellent success rate: 95 percent of patients experience immediate and dramatic relief following ETS

• The most advanced techniques in surgical procedures

• Our excellent network of medical professionals, including oncologists, gastroenterologists, and pathologists, working with our thoracic surgeons to ensure patients receive truly comprehensive care

• Treatments tailored specifically to our individual patients

Thoracic surgeons at NewYork-Presbyterian Hospital/Weill Cornell Medical Center are expanding the use of robotic surgery to the treatment of lung, esophageal, mediastinal, and thymic cancers and other disorders. They are able to perform some lobectomy, esophagectomy, and thymectomy procedures using this approach.

Advanced thoracic surgical options at Weill Cornell Medicine

During the robotic procedure, a Weill Cornell Medicine thoracic surgeon sits at a console, viewing the surgical field through the robot's "vision system." The surgeon uses controls to operate the various arms and cameras of the robot, which are placed into position in by surgical assistants.

Robotic thoracic surgery benefits patients by:

• Improving the surgeon’s vision of the area requiring operation

• Increasing precision

• Improving the overall success of minimally invasive surgical techniques, which decrease blood loss, minimize pain, and require a shorter recovery period

Expert surgical treatment for thymoma

The thymus gland produced white blood cells, which protect the body from infections. It is found in the upper chest, under the breastbone.

Thymomas are cancerous tumors that develop on the surface of the thymus gland. People living with an autoimmune disease (such as Myasthenia gravis) have a greater risk of developing thymoma. Symptoms include coughing, trouble breathing, and chest pain.

This condition is most frequently found during routine chest x-rays. The diagnosis is confirmed with additional imaging tests, such as a CT scan, MRI, or PET scan.

The most common treatment is surgery to remove the tumor. Additional treatments may include radiation therapy, hormone therapy, or chemotherapy.

Why choose Weill Cornell Medicine for robotic thoracic surgery?

The Department of Cardiothoracic surgery offers patients:

• The most advanced equipment and technology is used for all of our procedures

• An excellent network of medical professionals, including oncologists, gastroenterologists, and pathologists, working with our thoracic surgeons to ensure patients receive truly comprehensive care

• Treatments tailored specifically to each individual patient

• Our record of excellent outcomes — among the best in the nation — with a very low rate of complications

• Expertise in operating on patients with other health problems (such as diabetes, kidney problems, or others) and those who are elderly

Clinical Trials Open to Thoracic Surgery Patients 

Durvalumab (MEDI4736)

The purpose of this study is to find out the effectiveness of the drug, called durvalumab (MEDI4736), for treating Stage I, II, and IIIA non-small cell lung cancer, either prior to surgery and one year following surgery.

Principal Investigator: Nasser Altorki, MD
Contact: Cathy Spinelli, R.N. caf2007@med.cornell.edu, (212) 746-3328
ClinicalTrials.gov Identifier: NCT02904954

Atezolizumab (MPDL3280A)

This is a phase III, global, multicenter, open-label, randomized study. The purpose of this trial is to compare the efficacy and safety of 16 cycles (one cycle duration = 21 days) of atezolizumab (MPDL3280A) treatment with best supportive care (BSC).

This study focuses on patients with Stage IB and IIIA non-small cell lung cancer following resection and adjuvant chemotherapy, as measured by disease-free survival (DFS) as assessed by the investigator and overall survival (OS). After completing up to four cycles of adjuvant cisplatin-based chemotherapy, participants will be randomized in a 1:1 ratio to receive atezolizumab for 16 cycles or BSC.

Principal Investigator: Nasser Altorki, MD
Contact: Cathy Spinelli, R.N. caf2007@med.cornell.edu, (212) 746-3328
ClinicalTrials.gov Identifier: NCT02486718