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Thoracic Surgeon Brings New Procedures to Black Hills

Nov 29, 2016 10:00AM ● By MED Magazine
By Alex Strauss

By the time a patient with esophageal cancer is symptomatic, the malignancy is typically in an advanced stage. Which is why three esophageal cancer success stories at Regional Health’s Rapid City Regional Hospital in recent months are particularly notable.

“Two patients received radiation and chemotherapy prior to surgery along with percutaneous 
 endoscopic gastrostomy (PEG) for nutritional support and the third was not a candidate for neoadjuvant chemoradiation because of his comorbidities so we took him directly to surgery,” explains Dr. Zahir Rashid, the Black Hills region’s first fellowship-trained thoracic surgeon. A graduate of the Thoracic & Cardiovascular Surgery Fellowship program at the Medical College of Wisconsin, Dr. Rashid joined Regional Health in May 2016.

In all three recent cases of esophageal cancer, Dr. Rashid performed the region’s first transhiatal esophagectomies. With the aid of video scope (to free the esophagus from the neck), the new approach allows the surgeon to remove portions of the diseased esophagus through the left side of the neck after mobilizing the stomach through an abdominal incision.

“With this procedure, we pull up the freed stomach to the left side of the neck. We leave about a quarter of the length of the esophagus behind and we then connect it to the stomach,” says Dr. Rashid.
Although the risk of anastomotic leakage is slightly higher with this approach of doing the anastomosis in the neck, Dr. Rashid says this approach dramatically lowers the risk of complications and even death compared to doing a right thoracotomy and doing the anastomosis in the right chest.

“If there is leakage in the right chest, the risk of death is much higher,” says Dr. Rashid. ”If it leaks in the left side of the neck, the mortality rate is very low ‒ not even 5 percent. You can easily drain it and people don’t tend to develop sepsis and other problems.”

“The most compelling argument against an intrathoracic anastomosis is that while the rate of anastomotic leak is lower in the transthoracic approach (3-12 percent versus 10-25 percent in cervical anastomoses), the leak-associated mortality rate from intrathoracic leaks has historically been much higher (up to 50-70 percent versus less than 5 percent in cervical anastomoses),” explains Dr. Rashid. “Of course, with improved techniques and knowledge, results are getting better with both approaches.”

Dr. Rashid’s expertise in the surgical treatment of lung diseases, including VATS segmentectomy, lobectomy, biopsy, wedge resection, decortication and other procedures ‒ has also brought an influx of these patients to Regional Health.

“We have done more than 60 lung cases since I have been here. Last year, this facility did only a few cases,” says Dr. Rashid.

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