UNLV Medicine Newsletter

Volume 20 - July 20, 2021

TRANSFORMING HEALTHCARE

Friends & Colleagues,

When I think about how UNLV Medicine and University Medical Center (UMC) have once again worked together -- this time to produce a state-of-the-art biopsy system that can produce an often life-saving early diagnosis of lung cancer -- I'm reminded of an observation by the late Yale professor H.E. Luccock: “No one can whistle a symphony. It takes a whole orchestra to play it.”

That observation certainly rings true in any analysis of UNLV Medicine, the clinical arm of the Kirk Kerkorian School of Medicine at UNLV, and UMC, the state’s only level I trauma center, as well as the state’s only burn care center, transplantation center, and designated pediatric trauma center. Working together we’ve learned how what we accomplish goes a long way toward transforming healthcare in Southern Nevada. At UNLV Medicine, we’re proud that our physicians have the opportunity to help orchestrate the medical care that continues to underpin UMC’s nationally honored centers of excellence.

In a release to the media, UMC, our main teaching hospital, noted what the latest collaboration between the state’s two healthcare powerhouses has meant to the acute care hospital: “UMC, in partnership with UNLV Medicine, has become the first and only hospital in the state to introduce the groundbreaking ION system, a robotic-assisted platform for minimally invasive lung biopsy procedures.”

Today’s newsletter focuses on this procedure and Dr. Arthur Romero, the UNLV Medicine physician who is the state’s first fellowship-trained interventional pulmonologist, a man dedicated to improving lung healthcare in the Silver State.

Michael Gardner, MD, MPH, MMM

President & CEO, UNLV Medicine

Vice Dean of Clinical Affairs

Kirk Kerkorian School of Medicine at UNLV

Medicine By The Numbers

Lung Cancer Estimates

In The U.S. For 2021

About 235,760 new cases of lung cancer (119,100 in men and 116,660 in women).

About 131,880 deaths from lung cancer (69,410 in men and 62,470 in women).

Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in 15. For a woman, the risk is about 1 in 17. These numbers include both smokers and non-smokers. For smokers, the risk is much higher, while for non-smokers the risk is lower.

Black men are about 15% more likely to develop lung cancer than white men.

The rate is about 14% lower in black women than in white women.

Black and white women have lower rates than men, but the gap is closing.

The lung cancer rate has been dropping among men over the past few decades, but only for about the last decade in women.

Lung cancer mainly occurs in older people. Most people diagnosed with lung cancer are 65 or older, with the average age being 70.

A very small number of people diagnosed are younger than 45.

Lung cancer is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths.

Source:

https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html

UNLV Medicine and UMC Build The First Interventional Pulmonology Program In Nevada

Dr. Arthur Romero, assistant professor of pulmonary and critical care medicine and UNLV Medicine physician, helps patients with advanced lung diseases through minimally invasive procedures.

In June at UMC, UNLV Medicine’s Arthur Oliver Romero, MD, got an opportunity to use the advanced fellowship training in interventional pulmonology he received at the University of California San Francisco (UCSF).

And he may well have saved a life.

Using the robotic-assisted ION platform designed by Intuitive Surgical that was recently acquired by University Medical Center (UMC) -- the first and only hospital in the state with the groundbreaking program -- Dr. Romero diagnosed a patient with early-stage lung cancer. Diagnostic tissue from the hard-to-reach lesion was collected through robotic bronchoscopy and this information was given to a surgeon. Less than two weeks later, the patient underwent surgery to remove the tumor.

“That patient’s lung cancer is now gone,” said Dr. Romero. “We got it out before there was any evidence of spread.”

The ION system provides new levels of precision, reach and stability when compared to manual biopsy techniques. The ION has an ultra-thin, easily controllable catheter that can bend 180 degrees in all directions.

Arthur Romero, MD

Doctors can use the catheter to navigate through the lung to reach nodules in any airway segment. The robotic biopsy needle can also pass through very tight bends via the catheter to collect tissue in the peripheral lung, enabling a more precise biopsy and safer experience for patients.

Almost 1 in 4 cancer deaths are due to lung cancer, making it the leading cause of cancer death among both men and women. More people die annually of lung cancer, over 130,000 people, than the combined deaths from colon, breast and prostate cancers.

The intense interest by Dr. Romero in caring for people with lung cancer began during a combined three-year postgraduate pulmonary critical care fellowship between 2007-2010 at UCSF Fresno. As a pioneer in Nevada, he was the first one to use electromagnetic navigation bronchoscopy to biopsy previously unreachable lung nodules. He managed complex cancer cases with his multi-disciplinary team at UMC. As much as he was already helping a lot of patients, there were more that needed an even higher level of care. With support from a UNLV grant, he went back to UCSF in 2019 for a year-long advanced fellowship in interventional pulmonology, where the emphasis was on learning minimally invasive procedures to help patients with lung cancer and other advanced lung diseases.

Armed with better skills and broader experience dealing with the most complicated patients, Dr. Romero is now building the first interventional pulmonology (IP) program in Nevada. He is poised to help not only patients with lung cancer but other forms of advanced lung disease.

Angelica Honsberg, MD, the pulmonary critical care division chief for the Kirk Kerkorian School of Medicine -- she oversees the care of the sickest COVID-19 patients in UMC’s intensive care unit (ICU) -- says the new interventional pulmonology program at UMC will make a significant difference in lung disease care in Southern Nevada. She notes that Dr. Abhishek Kumar, another fellowship-trained interventional pulmonologist, recently joined the medical school and should prove to be a valuable addition to the new program.

“We’re taking a big step forward for the people of Nevada...People will be able to get world-class treatment right at home.”

Arthur Romero, UNLV Medicine Physician

“Historically,” she says, “there has been a gap in lung cancer care in our area, with many residents being diagnosed at an advanced state of disease and not having consistent access to more advanced interventions…The new interventional pulmonology program, created through the joint efforts of the Kirk Kerkorian School of Medicine and UMC, offers Southern Nevada residents options for both lung cancer and severe emphysema treatment that they previously would have had to travel elsewhere to have...Our department is confident that being able to offer more options to Southern Nevadans...will improve both quality of life and survival.”

UMC CEO Mason Van Houweling is no less confident in what the new ION program means to area lung cancer patients.

Dr. Romero and medical colleagues after the completion of the first robotic-assisted case.

“The ION system,” he says, “will serve as a valuable tool to help our world-class clinicians diagnose lung cancer and move patients rapidly to treatment.”

Dr. Romero, who still must spend much of his time treating COVID-19 patients -- he’s also performing tracheostomies to decrease patients' time in the ICU -- is thankful for the partnership between UNLV Medicine and UMC. “Without UMC acquiring the most advanced equipment available, I would not be able to offer the best care to many of our lung cancer patients.”

Robotic bronchoscopy, which Dr. Romero uses for minimally invasive access to virtually any part of the lung, also allows for the delivery of dye markers to aid a surgeon on removing as little of the lung as possible. He’s also treating patients through rigid bronchoscopy, a therapeutic modality where a hollow metal tube is placed in the airway to facilitate the removal of airway tumors, relieve strictures and even placement of airway stents.

Soon, Dr. Romero says the new IP program will offer bronchoscopic lung volume reduction, which is for patients with severe emphysema. It involves the placement of valves in the airways with the purpose of collapsing the worst functioning lobe of the lung. This allows other healthier parts more room to expand with the goal of relieving the patient’s shortness of breath and exertional limitations.

In addition, Dr. Romero says other novel procedures being developed and soon to be offered are: medical pleuroscopy, where a camera is placed in the space between the lungs and the chest wall to evaluate and treat hard-to-diagnose cancer and infections; and lung cryobiopsy, where a catheter that can achieve extremely cold temperatures is used to freeze lung tissue that is extracted with the use of a bronchoscope. This allows for non-surgical biopsy of interstitial lung disease, which describes a large group of disorders, most of which cause progressive scarring of lung tissue.

“We’re taking a big step forward for the people of Nevada,” Dr. Romero says. “People will be able to get world-class treatment right at home.”