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Voices of MCMS:

Thoracic Surgery at City of Hope

A conversation with Peter Baik, DO, FACOS, FACS, of City of Hope.

MCMS: Dr. Baik, you’ve transitioned from Chicago to the Arizona market for City of Hope. Welcome to town. What are some of the cases that you see as a thoracic surgeon?

Dr. Baik: I see the whole gamut of cases. From lung cancer, the most common type of cases, to mediastinal tumors, thymic cysts, mediastinal masses, nodules, cysts, and chest wall lesions. I see a lot of metastatic diseases, treating oligometastatic or trying to get diagnosis of the lesions in question. Of course, we have lymph nodes that need to be taken out for lymphoma diagnosis. I do esophageal work as well, but with the esophagus, we don't see many early-stage patients, mostly lung pulmonary cases.

 

MCMS: What brought you over to oncology surgery from whatever you were doing before?

Dr. Baik: You get exposed during your residency. I thought I wanted to do either minimally invasive or vascular cases. Then, I ended up spending time with Dr. Leonard Bailey at Loma Linda, who has since passed away. I spent a couple of months with him doing congenital heart surgeries and I thought that was just the most amazing thing. Once I had my own kids, there's a lifestyle that's not conducive with being a heart surgeon. Because of my interest in minimally invasive, thoracic oncology fit perfectly. For cancer surgeries, we want patients to recover from surgery as quickly as possible so that they can get additional treatments if needed. I saw that as an awesome opportunity to pursue.

MCMS: Are there factors of oncology patients that make surgery risky?

Dr. Baik: The most complicated things to me are patients who are currently receiving treatments. The multidisciplinary approach is important. We need to have good communication with other doctors, especially radiation oncologists and medical oncologists about when to operate. For certain medications like chemotherapies, you do not want to operate on patients unless they’re off it for six weeks because it impairs wound healing. The wounds will break down. The last thing you want to see is a lung herniating through the chest wall. At City of Hope, we see some very interesting and rare cases without much literature to tell us what we need to do, but City of Hope offers more colleagues to discuss cases. They’re here in Arizona or in Chicago or California or community doctors who joined the thoracic tumor board. Some of those people are gurus in thoracic oncology and they know a lot of contacts, as well. That opened so many more doors to find the best treatments for patients.

MCMS: You now have the cancer boards and tumor boards to coordinate care. Is there something else that brought you to City of Hope?

Dr. Baik: Working for this organization was my first job after fellowship. One of the reasons why I decided to join the system is because we are not trying to do too many things. We're concentrating on cancer care. Of course, there's some benign lesions that we have to do, but we’re mostly concentrating on cancer and just focusing on that. Everyone is on the same page, which is great. And our mission is to make sure that we take care of the patients as best as we can, and it makes communication much easier. It's not a huge hospital system. It’s a community oncology practice, where I can talk to someone down the hallway and for me it's ideal.

 

MCMS: You mentioned your interest in minimally invasive. How do robots or video assisted techniques help to reduce risk and improve outcomes?

Dr. Baik: The most important thing about minimally invasive surgery is that we have to know when not to use it. Minimally invasive surgery cannot be performed in every single case. If you have a huge, 10-centimeter anterior mediastinal mass, then you don't want to use a robot to get that out because if the lesion is thymoma, you could injure the mass itself and get spread. We know that open is the way to go. But with minimally invasive, as we get better at the procedures, we could do more things with it. For example, with chest wall lesions involving one segment of the rib, we can use three small incisions instead of making a bigger incision, cutting the rib. I could just do it using robotics and it cosmetically looks better, but more importantly, we can do a procedure where, ontologically, we get good margins. The gold standard is an open procedure for lobectomies or segmentectomy. We have to ensure that minimally invasive will be able to do it but with less pain. If you're doing lung cancer surgery and you get a posterior lateral thoracotomy, that's going to hurt. I know there are a lot of golf golfers out here and they’re not going to be able to play golf for six or eight months. But with minimally invasive, there are patients who go back sooner to play, and they don't have any issues.

 

MCMS: Do you see the gap closing overtime between robotics and open?

Dr. Baik: Definitely. Greater than 90% of my cases are all done using the robot. Especially with oligometastatic diseases or lung cancer surgeries, using robots is the way to go.

MCMS: Do you have any ways of explaining complex procedures to patients and families in a simpler way that they can understand?

Dr. Baik: Most of my consultation time is spent showing them images, going over CT scans, PET scans. The reason why is I'm a very visual person. I assume that a lot of the patients are visual. If you’re told you have a two-centimeter nodule in the right middle lobe, what does that mean to you? But if you see a picture and you see the two-centimeter lesion, then you have a better understanding. If I say the lesion is central where I cannot do a segmentectomy, sublobar resection, you may say, “Why? The tumor cell is small.” I can show how being central and to get good margin, I may injure the pulmonary artery, or if I have to do a bilobectomy, meaning taking the middle lobe and the upper lobe out because the vessels running right next to the mass cannot be saved. Then patients have a better understanding of why the surgical plan is being proposed.

 

MCMS: It would be nice to have a 3D version or hologram to show people. What do patients tell you about the impact that your team has had on their care?

Dr. Baik: We try to get the patients in as soon as possible, to get the treatments going as soon as possible. Whenever patients hear the word cancer, the whole world is just kind of flipped upside down. A lot of times they're not going to remember half the things you tell them.

MCMS: We call it the big C for a reason. You don't even want to say it.

Dr. Baik: You don't. But we know it's going to happen. What we try to do is to help them understand what's going on and how we’re going to tackle it. Sometimes, just sitting down and talking with them opens their eyes. The other thing is how we try to get things done as quickly as possible. For example, one of the oncologists may think a patient needs surgery. He or she will contact me to look at the records. Using telehealth, I can call the patient to review the images and go over the risk/benefit, and then I could have them get the staging done by one of our pulmonologists or interventional radiologists. I could get them on the table in two weeks. The longer they wait, patients become more anxious. They don't want to fall through the cracks. How often do we see patients who were found to have lung nodules six months ago? They were either not told or they forgot, and it becomes too late.

 

MCMS: What motivates you every day to see patients?

Dr. Baik: I'm a very technical person. I like to work with technology. I mean, it's amazing to operate on patients. Not all cases are the same and certain patients are more challenging. But I like getting it done and then see patients recovering well, especially when they say, “Oh my gosh, this was much easier than I thought.” It’s amazing that I could offer that. Of course, most surgeons are happy when they’re operating.

 

MCMS: Thanks for your time.

Dr. Baik: Thank you.

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