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 uses the latest technology to diagnose and treat a variety of lung conditions using minimally invasive techniques. Interventional pulmonologists undergo advanced training to provide these specialized services.

At Weill Cornell Medicine, interventional pulmonologists are part of a team of experts that provide comprehensive care to patients with complex chest disorders. This team includes thoracic surgeons, medical oncologists, radiation oncologists, interventional radiologists and ENT (ear-nose-throat) specialists.

Our Services

• Lung Cancer Screening Program — This program provides comprehensive evaluation for patients with pulmonary nodules. We also offer lung cancer screening to appropriate patients using a low dose chest CT.

• Advanced Bronchoscopy Program — Bronchoscopy is a diagnostic tool that allows us to examine your air passages by inserting an instrument called a bronchoscope. 

• Endobronchial Ultrasound (EBUS) — EBUS assists in diagnosing lung nodules and enlarged lymph nodes in the chest without surgery.
• Electromagnetic Navigational Bronchoscopy — This method uses a catheter with GPS tracking capabilities to locate difficult-to-reach lung nodules.
• Insertion of fiducial markers — These tiny gold seeds are placed in or near a tumor as a point of reference during stereotactic radiosurgery. 
• Narrow Band Imaging — This technique uses light in blue and green wavelength spectrum to enhance certain aspects of airway lesions.

• Complex Airway Disease Program — We provide customized care for patients with cancer or non-cancer airway disorders.  These conditions include:

• Relief of obstruction affecting the windpipe (trachea) and main bronchi
• Management of tracheostomy-related complications
• Treatment of tracheal scarring (the narrowing of windpipe)
• Evaluation and management of tracheobronchomalacia (TBM), an under-recognized condition resulting from excessive narrowing of main air passages during exhalation. TBM commonly causes chronic cough and shortness of breath that do not improve with standard treatment.

Our Treatments

We use a variety of advanced endoscopic techniques to perform procedures that were traditionally not possible or required extensive surgery. These include:

• Rigid and flexible bronchoscopy — This procedure uses a combination of metallic and fiberoptic cameras to examine the tracheobronchial tree.
• Cryotherapy — Cryotherapy uses cold nitrous oxide gas to freeze tumors or remove foreign bodies.
• Hot therapies — Examples of this type of therapy include Argon plasma coagulation (APC) and laser. During treatment, APC or lasers are used to burn the tumor and control bleeding.
• Airway Stenting — In this procedure, surgeons insert a metallic and silicone prosthesis to open up a blocked or closed airway.
• Endobronchial brachytherapy — Using a bronchoscope, physicians deliver a high dose of internal radiation to rapidly destroy a tumor blocking the trachea or bronchi.
• Photodynamic therapy — Photodynamic therapy is a light-based therapy delivered via a bronchoscope to destroy a tumor blocking the trachea or bronchi.

Pleural Disease Service

Pleural effusions occur when fluid accumulates between the lung and the pleura, the thin membranes that line the lungs and the inside of the chest cavity.

Weill Cornell Medicine offers a variety of treatments depending on your condition, including:

• Ultrasound-Guided Thoracentesis and Chest Tube Placement — In this procedure, we use a small catheter to remove pleural fluid. An ultrasound helps physicians determine where to insert the catheter making procedure safe.
• Tunneled Pleural Catheter — This option allows patients to leave the hospital with a pleural drain, thereby allowing patients to drain fluid at comfort of their home.
• Pleuroscopy — A pleuroscopy is a direct examination of the outer layer of the lung using a small camera through a single incision which allows physicians to determine the cause of fluid buildup. Pleural biopsies are performed under direct optical control

Endobronchial Treatment of Asthma and COPD (chronic obstructive lung disease) includes:

• Bronchial Thermoplasty Program — This novel bronchoscopic procedure offers additional treatment options for patients with severe asthma not responding to medical therapy.
• Endobronchial Lung Volume Reduction — This is a new bronchoscopic treatment option for select patients with severe emphysema that has been shown to improve breathlessness. Learn more about this procedure.

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    

What is Thymoma?

Thymoma is a rare disease in which malignant, or cancerous, cells form tumors on the outside of the thymus. The thymus makes white blood cells, call lymphocytes, that protect the body against infections. This small organ is located in the upper chest under the breastbone, anterior to the heart and blood vessels.

Thymomas tend to grow slowly in the cells that make up the thymus. Rarely, they spread outside of the thymus, although aggressive thymomas can spread to neighboring organs or to blood vessels or nerves in the chest or the lining of the lung (known as the pleura). 

Signs and Symptoms

In many cases, thymomas do not cause early signs or symptoms. Often, these tumors are discovered while testing for other conditions or during a routine X-ray. When symptoms are present, they include:

• A cough that does not go away.
• Chest pressure or pain.
• Trouble breathing. 

Many people with thymoma also have autoimmune diseases, in which their immune systems attack healthy tissue and organs. Sometimes removing the thymoma, or in some cases even removing a normal thymus, can help relieve the symptoms of these diseases, particularly myasthenia gravis.  Autoimmune diseases typically associated with thymoma include:

• Myasthenia gravis.
• Acquired pure red cell aplasia.
• Hypogammaglobulinemia.
• Polymyositis.
• Lupus erythematosus.
• Rheumatoid arthritis.
• Thyroiditis.
• Sjögren syndrome. 

Treating Thymoma

Removing the tumor through surgery is the most common way to treat thymoma. However, some patients may combine surgery with other treatments, such as chemotherapy and radiation therapy.

Weill Cornell Medicine offers the full range of surgical treatments.  Over 90 percent of our procedures are performed minimally invasive. Patients typically experience less scarring, less pain and a shorter hospital stay than when thymomas are removed through a sternotomy or thoracotomy.

Treating Thymoma

Weill Cornell Medicine also offers robotic surgery to treat Thymomas. We are a leader in this approach, which is less invasive and more precise than traditional open surgery. Robotic surgery is usually less painful and leads to less scarring than open surgery. In most cases, patients also experience decreased postoperative complications and shorter hospital stays.

During robotic thymoma surgery, surgeons insert a tiny camera and surgical instruments through small incisions in the chest. The camera enhances surgeons’ vision of the thymoma and of surrounding structures, while the surgical instruments allow them to make more controlled, precise movements.

Clinical Trials

Weill Cornell Medicine physicians are also scientists focused on finding new and better ways to diagnose and treat diseases. Clinical trials give patients access to the latest scientific advances, including treatments that may not be found anywhere else.  We also offer biobanking and specialized molecular testing for some thymomas or thymic cancers.

Visit our department website for more information about clinical trials that may be available.

Why Choose Weill Cornell Medicine?

Technical Expertise

At Weill Cornell Medicine, patients receive compassionate care from internationally recognized innovators and leaders in the field. Our surgeons have extensive experience with complex thoracic issues. We employ the latest medical and surgical advances.

Weill Cornell Medicine, in partnership with NewYork-Presbyterian – New York’s top hospital for 18 years running, according to U.S. News and World Report – is also a major referral center that draws patients from across the country and around the world.

Our Patient-Centered Approach

Weill Cornell Medicine also employs a patient-centered approach:

• Patients always talk to a live person on the phone, never to voicemail.
• Telemedicine consults are available for patients who live far away.
• We carefully assess your individual situation and collaborate with you to create a personalized care plan.
• We monitor our patients closely after surgery, which is why our surgical outcomes routinely surpass regional and national benchmark statistics for mortality and major complications.
• We are judicious in the choice of tests and procedures we choose for you. We are consistently aware of the need to contain healthcare costs. 

Schedule an appointment with one of our physicians today or contact us to learn more about our approach to cancer care.