The Lung Institute at Baylor Medicine

It is so good to know that even the @Pontifex had a minimally, invasive lung cancer resected!

Healing an esophageal leak takes more than placing a stent. At the Baylor College of Medicine Lung Institute, we emphasize the principles that support successful healing: ⚪️ A healthy, well-perfused conduit—stenting cannot rescue circumferential necrosis. Trying to stent a dead conduit is a waste of time. ⚪️ Effective drainage of all contaminated pleural collections and the leak. ⚪️ Protection of the lung and airway (and aorta!) from stent exposure and erosion. ⚪️ Vascularized tissue, such as an omental flap placed at the time of surgery or a muscle flap placed after the leak when operative repair is appropriate. ⚪️ Endoscopic vacuum therapy in selected patients to promote concurrent drainage and granulation. (But this requires a long inpatient hospital stay and frequent trips to the OR and a distal feeding tube) Our accompanying guide highlights the five patterns of esophageal stent leakage described in my publication with Dr. Elizabeth Stephens et al. Recognizing the mechanism helps guide the next intervention. Stephens EH, et al. Ann Thorac Surg. 2014;98:297–304. doi.org/10.1016/j.athoracsur… #EsophagealSurgery #ThoracicSurgery #SurgicalEducation @BCMLungInst @bcmhouston

Foreign bodies near the esophagus can create lasting challenges. At the Baylor College of Medicine Lung Institute, revisional foregut surgery requires careful evaluation and an individualized plan. ⚪️ LINX® removal may be necessary for erosion, clinically significant device-related metal allergy, or persistent dysphagia and narrowing that fail appropriate dilation. ⚪️ Gastric bands may require removal for slippage, stomach prolapse above the band, erosion, herniation, or persistent difficulty swallowing. ⚪️ Hiatal mesh can complicate revision through scarring, narrowing, or erosion. Risks differ by material, and current evidence does not establish a routine role for mesh in every hiatal repair. ⚪️ Whenever feasible, I favor primary hiatal closure and minimizing foreign material near the esophagus—with preservation of swallowing and protection of healthy tissue guiding the operation. @bcmhouston @BCMLungInst #ForegutSurgery #RevisionalSurgery #Dysphagia #HiatalHernia #BCMLungInstitute

When cancer spreads to the lungs, when should we biopsy—and when should we resect? At the Baylor College of Medicine Lung Institute, these decisions begin with a clear goal: obtaining information that changes treatment or providing meaningful control of disease. ⚪️ Will tissue change care? Biopsy can distinguish a metastasis from a new primary lung cancer or a benign process and provide molecular information to guide therapy. ⚪️ What is the tumor’s biology? Cancer type, disease-free interval, growth rate and responsiveness to systemic therapy help determine whether local treatment makes sense. ⚪️ How many tumors are present—and where? Size, number, distribution and proximity to major airways or blood vessels affect our ability to treat lesions safely while preserving lung function. ⚪️ Can disease outside the lung be controlled? The primary tumor and other metastatic sites must fit into a coordinated treatment plan. ⚪️ Can we achieve complete treatment with acceptable risk? Lung reserve, overall health, recovery burden and the patient’s goals matter. ⚪️ Which approach best serves the goal? Options include Ion robotic navigational bronchoscopy or percutaneous biopsy, surgical resection, microwave ablation, cryoablation and stereotactic radiation. Bronchoscopic ablation and pulsed electric field therapy are emerging approaches with evolving evidence. Careful selection is essential. Local treatment may benefit selected patients, but a survival benefit cannot be assumed for everyone. Multidisciplinary review helps match the right intervention to the right patient. #LungMetastases #ThoracicSurgery #PrecisionOncology @bcmhouston @BCMLungInst #LungInstitute

I couldn’t think of a better person to do this job. Dr.Scott LeMaire @scottlemaire is easily one of the brightest, most competent, most intelligent and most capable surgeons I know. President of @stsa1954 and #JTCVS!

Did you know that small cell lung cancer (#SCLC) can sometimes be treated with surgery when it is found very early? Early diagnosis is critical. Our new Baylor College of Medicine Lung Institute clinical algorithm highlights the importance of: 🫁 Early detection 🧠 Brain MRI staging 🔬 EBUS & mediastinal lymph node evaluation 📋 Guideline-based treatment planning 🤝 Multidisciplinary care For carefully selected patients with a small peripheral tumor & no lymph node involvement, surgery may be part of the treatment plan before additional therapy. If you have been diagnosed with lung cancer—or are at high risk—ask your physician whether comprehensive staging and multidisciplinary evaluation are right for you. Early detection saves lives. Learn more at @BCMLungInst ⁠ #LungCancer #SmallCellLungCancer #SCLC #LungHealth #ThoracicSurgery #EarlyDetection #LungCancerAwareness #CancerCare #PrecisionMedicine #EBUS #BrainMRI #LungScreening #MultidisciplinaryCare #BaylorCollegeOfMedicine #BCMLungInstitute #ThoracicOncology #GuidelineBasedCare #NCCN #HopeStartsHere

Anterior mediastinal masses require a systematic, multidisciplinary approach to ensure the right diagnosis and the safest path to treatment. Our latest Baylor College of Medicine Lung Institute clinical algorithm highlights: 🔹 Imaging features that narrow the differential diagnosis 🔹 Targeted laboratory evaluation (LDH, β-hCG, AFP, TSH, Free T3, Free T4, and acetylcholine receptor antibodies) 🔹 When to observe versus pursue tissue diagnosis 🔹 Choosing the optimal biopsy approach—ultrasound-guided, CT-guided, mediastinoscopy, or Chamberlain procedure 🔹 Recognition of lymphoma, thymoma, germ cell tumors, thyroid lesions, lymphangiomas, and mediastinal cysts Standardized pathways help reduce unnecessary procedures, improve diagnostic accuracy, and ensure patients receive timely, evidence-based care. #ThoracicSurgery #MediastinalMass #Thymoma #Lymphoma #GermCellTumor #ThoracicOncology #LungInstitute #BaylorCollegeOfMedicine #MedEd #MedicalEducation #ClinicalAlgorithm #EvidenceBasedMedicine #ChestSurgery #PulmonaryMedicine #Radiology #Pathology #MultidisciplinaryCare

Patients who have end stage #achalasia with #megaesophagus who fail #POEM or minimally invasive surgical #myotomy w/ a #POPE may benefit from a #MIE #MinimallyInvasiveEsophagectomy. But a RAA #RightAorticArch and prior #GBP #GastricBypass complicate the evaluation. He we we present the facts on one page... @BCM_Surgery @BCM_CTSurgery

Surgical Paraesophageal Hernia Pearls:⚪️⚪️⚪️⚪️⚪️ #Borchardt’s Triad is a Thoracic Surgical Emergency A patient with a known (or suspected) paraesophageal hernia who presents with severe epigastric/chest pain, persistent retching without productive vomiting, and inability to pass a nasogastric tube has Borchardt’s Triad until proven otherwise. This should immediately raise concern for acute gastric volvulus with potential strangulation. Key Surgical Pearls: ⚪️Obtain an urgent CT scan to define anatomy, assess for volvulus, ischemia, perforation, or mediastinal contamination. ⚪️If there is no evidence of gastric necrosis, perforation, or uncontrolled bleeding, involve an advanced therapeutic endoscopist (or surgical endoscopist) early for urgent endoscopic decompression and NG tube placement to allow the patient and their stomach to recover. ⚪️Successful decompression often converts an emergency operation into a planned minimally invasive paraesophageal hernia repair after several days of physiologic recovery and optimization. Do NOT discharge until they have been repaired. ⚪️Do not delay surgery if imaging or endoscopy demonstrates gastric ischemia, necrosis, perforation, or an irreducible volvulus. These patients require immediate operative intervention, with gastric resection when necessary. ⚪️During definitive repair, perform careful mediastinal dissection, complete sac reduction, assessment of gastric viability, crural reconstruction, and an appropriate fundoplication or gastropexy based on patient anatomy and esophageal function. ⚪️Take-home message: Early recognition, prompt decompression when appropriate, and timely definitive repair can dramatically reduce morbidity while preserving the stomach whenever possible. #ThoracicSurgery #GeneralSurgery #ForegutSurgery #EsophagealSurgery #ParaesophagealHernia #GastricVolvulus #BorchardtsTriad #SurgicalPearls #MinimallyInvasiveSurgery #RoboticSurgery #PatientSafety #BCMLungInstitute

Esophageal cancer outcomes begin with accurate staging. Before selecting therapy, ensure every patient has a complete multidisciplinary evaluation. ○ Confirm the diagnosis with upper endoscopy and biopsy, documenting the tumor distance from the incisors and histology. ○ Stage comprehensively using CT, PET/CT, and endoscopic ultrasound (EUS) to define both local tumor extent and nodal disease. ○ Don’t overlook bronchoscopy for proximal or mid-esophageal tumors (≈25 cm from the incisors or more proximal) or whenever airway invasion is suspected. ○ Staging laparoscopy remains essential for distal esophageal and gastroesophageal junction adenocarcinoma to identify occult peritoneal metastases that may alter treatment. ○ Understand the Siewert classification—accurate localization of GE junction tumors guides staging, multidisciplinary planning, and operative strategy. ○ Molecular profiling is increasingly important, including HER2, PD-L1, MSI/MMR, and other biomarkers when appropriate. ○ Optimize patients before treatment with nutritional assessment, cardiopulmonary evaluation, and multidisciplinary tumor board review. MATTERHORN Trial Highlights ○ Perioperative durvalumab + FLOT improved event-free survival compared with FLOT alone. ○ Higher pathologic complete response rates were achieved while maintaining an acceptable safety profile. ○ Clinical benefit was observed regardless of PD-L1 expression, supporting broader application in appropriate patients. Every patient deserves thoughtful staging, evidence-based multidisciplinary care, and individualized treatment planning. #EsophagealCancer #GastroesophagealJunction #ThoracicSurgery #SurgicalOncology #GIOncology #CancerCare #PrecisionMedicine #Immunotherapy #MATTERHORN #FLOT #MultidisciplinaryCare #BaylorCollegeOfMedicine #BCMLungInstitute

Proud to be a part of this story…

Minimally Invasive Esophagectomy (MIE): Why It Matters Esophagectomy remains one of the most complex operations in surgery—but when performed by experienced teams, a minimally invasive approach can provide important benefits for many patients. ⚪️ Smaller incisions and less surgical trauma ⚪️ Reduced postoperative pain and opioid requirements ⚪️ Lower pulmonary complication rates in many studies ⚪️ Less blood loss and fewer wound complications ⚪️ Earlier mobilization and recovery ⚪️ Shorter hospital stay for many patients ⚪️ Comparable oncologic outcomes, including lymph node harvest and margin status, when performed by experienced surgeons ⚪️ Earlier return to quality of life and functional recovery Key point: ⚪️ The best approach is the one tailored to the individual patient. ⚪️ Tumor location, prior operations, patient anatomy, and surgeon experience all influence whether minimally invasive, robotic-assisted, hybrid, or open esophagectomy is the optimal choice. ⚪️ High-volume centers with multidisciplinary teams continue to achieve the best outcomes for patients undergoing esophagectomy. #EsophagealCancer #Esophagectomy #MinimallyInvasiveSurgery #RoboticSurgery #ThoracicSurgery #SurgicalOncology #EnhancedRecovery #CancerCare #BaylorCollegeOfMedicine #BCMLungInstitute @BCM_CTSurgery @bcmhouston

🧬 In NSCLC, the #mutation can change the treatment. For patients with non-small cell lung cancer (#NSCLC), precision oncology starts by asking a critical question: What is driving this tumor? 🔬 Test broadly. Comprehensive next-generation sequencing (#NGS)—ideally incorporating tissue and, when helpful, plasma ctDNA—can identify actionable alterations. ASCO recommends broad multigene biomarker testing and emphasizes having biomarker results available when treatment decisions are made. 🎯 Key actionable drivers include: EGFR • ALK • ROS1 • BRAF V600E • MET exon 14 • RET • NTRK • HER2/ERBB2 • KRAS G12C • NRG1 💊 Finding a driver may open the door to a matched targeted therapy—sometimes dramatically changing the treatment pathway. 🧠 And remember: PD-L1 alone is not enough. A high PD-L1 level does not replace comprehensive molecular testing when an actionable driver may be present. Biopsy → Stage → Sequence → Identify the driver → Match the therapy. Precision medicine means treating the biology of the cancer, not just where the cancer started. #LungCancer #NSCLC #PrecisionOncology #TargetedTherapy #GenomicTesting #NGS #Biomarkers #LungCancerResearch #ThoracicOncology #BCMLungInstitute

Surgery is only the beginning of recovery. After esophagectomy or complex esophageal reconstruction, patients may experience changes in swallowing, nutrition, reflux, dumping, aspiration, pain, breathing, and physical or emotional well-being—sometimes years after surgery. ⚪️survivorship should be a longitudinal program, not simply an annual visit. Using electronic patient-reported outcomes (ePROs), we can follow symptoms over time, benchmark recovery, and identify changes that may trigger earlier evaluation or intervention. 📊 Measure. Benchmark. Act. Longitudinal data can help us recognize when a patient needs: ⚪️Nutritional intervention ⚪️Swallow evaluation or dilation ⚪️Reflux or gastric-emptying assessment ⚪️Aspiration/pulmonary evaluation ⚪️Rehabilitation ⚪️Pain or psychosocial support ⚪️Expert evaluation of complex postoperative problems The goal after foregut surgery should be more than surviving the operation. We work to prevent aspiration, complications, and deconditioning. The goal is helping patients continue to improve their function, symptoms, independence, and quality of life for years to come. #EsophagealCancer #Esophagectomy #Survivorship #PatientReportedOutcomes #ePRO #ForegutSurgery #QualityOfLife #BCMLungInstitute

Not all diaphragm hernias are the same—and understanding the anatomy matters. ⚪️Congenital diaphragmatic hernias occur when an opening in the diaphragm allows abdominal organs to move into the chest. The lung cannot normally develop in some cases. ⚪️Bochdalek hernias develop posterolaterally, while Morgagni hernias occur anteriorly near the sternum. ⚪️Hiatal hernias are classified as Types I–IV based on the position of the stomach, gastroesophageal junction, and other abdominal organs. ⚪️Symptoms may include reflux, difficulty swallowing, chest or abdominal pain, vomiting, shortness of breath, or exercise intolerance. Repair generally involves returning the organs to the abdomen and closing or reconstructing the diaphragm or esophageal hiatus. ⚪️At the Baylor College of Medicine Lung Institute, multidisciplinary expertise helps patients from 5 TMC hospitals to receive the right diagnosis and an individualized surgical plan to preserve lung health as we work with patient to repair all types of hernias. @bcmhouston @BCMLungInst #DiaphragmHernia #ParaesophagealHernia #ThoracicSurgery #PatientEducation