An NCI-designated Comprehensive Cancer Center
By Abe Rosenberg | August 12, 2019
Lung Cancer Lung cancer
Yuman Fong, M.D.,  recalls his days in medical school, when Stage 4 colon cancer — cancer that has spread beyond the colon, usually into the liver — was considered inoperable and fatal.
“I still remember one patient who was having colon cancer surgery,” he said. “We detected one spot on his liver. The patient was offered hospice care.”
Back then, surgeons believed that cancer cells in the liver meant the disease had spread everywhere.
“We were really wrong,” Fong said. It was later proved that metastatic colon cancer frequently does not  spread beyond the liver. It can be treated.
Decades later, Fong, chair of City of Hope’s Department of Surgery and The Sangiacomo Family Chair in Surgical Oncology, has the team, the tools, the technology and the know-how to significantly prolong Stage 4 patients’ lives, and often cure them. When surgery is combined with chemotherapy, 60% of metastatic colon cancer patients at City of Hope have a five-year survival rate, with 40% cured.

Minimally invasive techniques

Innovations employed at City of Hope now enable surgeons to remove tumors in the colon and liver during the same operation, which means shorter hospital stays and faster recoveries. City of Hope pushed hard in support of the “all-in-one” approach, nearly always done with minimally invasive techniques.
“It has helped us minimize patient suffering,” said Fong.
It has also helped City of Hope earn a 13th consecutive U.S. News & World Report designation as a top cancer hospital. The magazine ranked City of Hope 11th in the nation and the best cancer facility in the West. It also singled out the colon cancer surgery and lung cancer surgery divisions as “high performing.”
“That’s a reflection on our entire team,” said Jae Y. Kim, M.D., chief of the Division of Thoracic Surgery. “I feel blessed to work with amazing colleagues so dedicated to the mission, who take such pride in their work. That’s the main reason why our results are so good.”
Better than good. Lung cancer surgery patients at City of Hope experience some of the lowest complication and mortality rates, as well as a higher-than-average overall survival rate, compared to baseline statistics provided by the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute. Skill and technology play major roles, to be sure. But Kim cites two other factors that go to the heart of the City of Hope philosophy: the multidisciplinary approach and an emphasis on patient-centered, compassionate care.
For example, some lung cancer patients at City of Hope receive immunotherapy drugs before surgery as part of a clinical trial. That combination “simply isn’t available at many other places,” Kim points out.

Assisting caregivers

Kim is also running a clinical trial that has nothing to do with drugs or scalpels. It’s a five-year National Cancer Institute-funded study aimed at improving the surgery experience for patient caregivers, the idea being that given the proper tools, caregivers can do a better job preparing patients for surgery and helping them with recovery afterward.
We want to do everything we can to help patients return to their normal lives as soon as possible,” Kim said.
One way to achieve that is to avoid undue disruption of those lives in the first place. Next-generation robotic technology can help. City of Hope was an early adopter of robotic surgery and has led the way in deploying precision robotics for a growing number of procedures — more than 12,000 total operations so far.
The latest robotic machines provide greater visibility and more freedom of movement, enabling surgeons to work on several different locations, and preventing them — through programmable artificial intelligence — from doing the wrong thing, like firing a stapling device in an incorrect spot. “We can compute where to go, where not to go, avoiding dangerous areas,” said Fong.
“People are starting to recognize us as a leader” in robotics, Fong added, pointing out that he and several City of Hope colleagues co-edit the SAGES Atlas of Robotic Surgery, considered the definitive, state-of-the-art guide to the field.

Robotics beyond surgery

The robotics trend is expanding beyond surgery into newer areas.
“We’ve purchased a robotic bronchoscopy system,” said Kim. This device makes it possible to send a camera and other tools down the patient’s airway “deeper than we could before” to detect and diagnose lung tumors previously unreachable except through surgery. City of Hope is the first facility in California to acquire the system.
Going forward, Fong and Kim both agree on what it takes to maintain the “high performing” standard.
“Our field is constantly changing,” Kim said. “We need to make sure we’re offering the most up-to-date, most effective treatments for each patient.”
To get there, said Fong, it’s important to expand the multidisciplinary approach, taking cancer treatment beyond just “removing the primary tumor. I want to see a generation of surgeons with expertise in all the available tools, so they’ll know how to give each patient the chance to live longer, so ultimately we can cure everyone.”

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