the 64 bulletin
The Jack A. Roth Fellowship in Thoracic Surgical Oncology – an Invaluable Experience Across the Pond Gerard J Fitzmaurice, Consultant Thoracic Surgeon, St. James’s Hospital, Dublin, Ireland
A
s the inaugural recipient of the Jack A. Roth Fellowship in Thoracic Surgical Oncology from the American Association for Thoracic Surgery, I had the privilege of visiting the Department of Thoracic & Cardiovascular Surgery at the University of Texas MD Anderson Cancer Centre (MDACC), arguably the world’s
The University of Texas MD Anderson Cancer Centre
pre-eminent cancer hospital. Professor Ara Vaparociyan follows in the footsteps of Professor Roth and leads this internationally renowned quaternary referral centre that specialises in the management of all complex thoracic malignancies, in particular lung cancer, mesothelioma, oesphagheal cancer, and mediastinal tumours. MD Anderson originally developed from humble quarters during the Second World War to now stand prominently in the skyline of the Texas Medical Centre, a sprawling medical campus home to some of the world’s foremost hospitals. Steeped in history at every turn, my early morning walk to MDACC took me along Bertner Avenue, named after Ernest Bertner one of the original founders of the Texas Medical Center and also the physician who delivered Denton A. Cooley, founder of The Texas Heart Institute. And just a block away stands the Baylor College of Medicine, home to
the Michael E. DeBakey museum, attesting to the extraordinary cardiothoracic surgical ethos embodied in Houston. The thoracic service is based in the dedicated thoracic centre and is a true multidisciplinary team with close collaboration between surgeons, pulmonologists, medical and radiation oncologists, radiologists, and pathologists. As the inaugural Roth fellow, I was fully integrated into all clinical and academic programs of the department. I attended daily morning rounds, selected the most opportune surgical cases to attend which included RATS sleeve lobectomies, VATS anatomical lung resections, major chest wall resections and reconstructions, thymectomies (minimally invasive approaches and standard median sternotomy), and resection of major intra-cardiac metastasis. It was fascinating to follow patients from discussion at the MDT with ongoing surgical trials including NEOSTAR and BRIGHTSTAR and observe the extraordinary effects of these new treatment modalities. I also had the opportunity to attend outpatient clinics, with the ensuing discussions around perioperative and long-term management, while developing a key insight into the logistics of running a complex patient load. The weekly tumour board meetings, discussing management options for complex thoracic malignancies, were particularly valuable as were the discussions surrounding the wealth of ongoing trials. The weekly research meetings, journal club, morbidity and mortality meetings, and teaching sessions were highly informative and provided me with valuable seed ideas to bring home.