American Physicians Network

Mobile menu contact icon

Mobile menu contact information

You are here: Home / News

News

by

Rehab services

We are excited to announce the addition of Rehabilitation services to our roster of accredited and American Physicians Network -credentialed providers.  This facility specializes in the treatment of serious neurological illnesses, injuries and conditions for clients recovering from traumatic brain injuries, brain tumors, strokes and congenital conditions.

They use a holistic patient centered approach utilizing a multi-disciplinary team of rehabilitation professionals to address the emotional, mental and physical care of their patients.  The outpatient rehabilitation center is packed with state-of-art diagnostic and treatment equipment including robotics that help to target, train and evaluate specific areas of the body to treat a wide range of conditions (upper and lower limbs, ambulation mechanics,  fine motor control etc.)

robotic equipment for physical therapy

We are so pleased to be able to offer this service to our clients.  We know, that with serious illnesses and injuries, a comprehensive rehabilitation program is a crucial component to enable our clients to reach their full potential, and enhance wellness and recovery.

by

Updates from the trip!

Our December escorted trip is almost over..  Several of our clients are home already, but everyone got excellent care, and had a great time too!

Most of my friends and clients know that when you come to APN – we treat you like family..   if that’s not enough, one of the clients on this trip – was my mom!  She came down with the group to be evaluated for severe aortic stenosis.  She lives in Canada, where healthcare is rationed – and at 80, remains otherwise healthy and very active.

I’ve included a video of her talking about her procedure – in her own words.  Here she is in the cardiovascular ICU, the morning after surgery on December 10th, 2019.

(All images and client information used with explicit permission).

by

Escorted trip – December 2019 almost full!

We still have over two months to go before our first Escorted client trip to Colombia, and the trip is almost full. We have clients with a wide variety of needs from all over North America.

The trip kicks off on December 1st when the last of our clients and staff arrive.   In addition to the usual medical appointments and such, we are planning on a few special events to commemorate our trip and all the wonderful people that are coming with us!

More news to come as December looms closer.

by

“This is Life” and more about Dr. Diego Gonzalez Rivas and minimally invasive thoracic surgery

Several of our clients have asked for more information about legendary thoracic surgeon, Dr. Diego Gonzalez Rivas and the uniportal video assisted thoracoscopic surgical technique which he pioneered in 2010.

We have posted two of the documentaries on Dr. Diego Gonzalez Rivas, the uniportal technique and his efforts to share this technique with the thoracic community.

Sharp-eyed viewers will catch a glimpse of one of our APN executives in both of these films.   The second film, “Seven Days, Seven Cities” explains and documents Dr. Gonzalez Rivas’ journeys during one week as he traveled across China to teach his technique.  It also highlights his training program in Shanghai, China and the work he is doing there.

As part of our exclusive referral network, clients may select Dr. Gonzalez (or another of our world- class thoracic surgeons) for their surgical care, for a fraction of the cost of care in the United States.

Excellent care, at an affordable price.

For more information about the thoracic surgeons in our network, or to schedule a medical evaluation, please contact us here at American Physicians Network.

by

Is there five year survival for patients with malignant pleural mesothelioma (MPM)?

Dr. Isik

Is there five year survival for patients with malignant pleural mesothelioma (MPM)?  This is just one of the many questions we asked during an interview with one of the surgeons in the APN network as part of a series discussing HITHOC (hyperthermic intra-thoracic chemotherapy) for malignant pleural mesothelioma and other cancers.

Today, Dr. Isik, a thoracic surgeon, with extensive experience with mesothelioma and HITHOC talks with APN.  We are discussing malignant pleural mesothelioma, the HITHOC procedure and the latest research findings in a Questions and Answers session.

WARNING:  This video contains graphic surgical images.

Full Transcript from video is below.

Q.  Would you please talk about your academic career briefly?

Dr. Isik:  I graduated from University of Ankara, Medical School in 1991 and attended to residency in thoracic surgery of same institute.  After getting to be Thoracic Surgeon in 1996, for 23 years I studied mostly on oncology especially lung, pleura and esophageal carcinoma. I have been working as consultant professor since 2013 in University of Gaziantep, Medical school, Thoracic Surgery Department. I am the chief in this department.

For pleural cancers, I have been studying on radical surgery plus hyperthermic intrapleural perfusion chemotherapy (HITHOC) since 2009. Especially in malignant pleural mesothelioma, pleurectomy/decortication and HITHOC intervention has been observed as feasible and improving survival for those patients. Also in stage 4 M1a lung cancer cases, oncological surgery including lung resection and pleurectomy plus HITHOC has improved life comfort and survival.

I established the Advanced Respiratory Biology Department in Medical Sciences Institute of University of Gaziantep in 2018 after took over the Basic Respiratory Biology program and cell culture laboratory in September 2016. Postgraduate program about cancers of respiratory organs has begun at September 2018. Since 2015, I have been proceeding the accreditation program of Medical School of University of Gaziantep as coordinator in self-evaluation committee.

I have been working on artificial respiratory center for patients with respiratory insufficiency and have patent on this subject named “Telemetric Diaphragm pacing with feedback”. I completed 7 projects about different subjects including experimental studies on animals and cell culture and infrastructure of medical school and its hospital. I have been member of Toraks, TUSAD, Turkish Thoracic Surgery Association, European Society of Thoracic Surgeons, European Respiratory Society.

HITHOC

Now that we know a little more about Dr. Isik, let’s talk more about HITHOC.  After all, that’s why most of our readers are here.

Q. Would you please describe us what HITHOC treatment is?

Dr. Isik:   Hyperthermic intrapleural chemotherapy (HITHOC) is an adjuvant intervention just after the radical surgery of pleura and lung if needed. [ During surgery, warmed up chemotherapy medications are applied directly to the tissue of the chest.  This is believed to kill any cancerous cells that are too small to be seen directly, so that no cancer is left behind].

In scientific investigations, it was found that hyperthermia leads apoptosis of cells. Apoptosis is one of the pathway of cell death. Cancer cells are immortal if they find suitable habitat in human body. Because of this, microscopic pleural seeding should be eradicated by another procedure after surgery. Heated intrapleural chemotherapy is an applicable and effective treatment used for this purpose. It is administrated just after surgery through pleural drainage catheters under general anaesthesia.

In the operating room

Q. What are the advantages of HITHOC treatment?

Dr. Isik:  Chemotherapeutic agents are toxic for human body and cells. For this reason, they cannot be given in high dosages in systemic applications. Hyperthermic intrapleural chemotherapy is a local intervention just after the surgery. So it possible to apply higher dosages of chemotherapeutic agents than systemic therapy, [directly to the affected tissue]. This is the advantage of the treatment. Despite these higher dosages than systemic therapy, we see lesser renal and cardiac complications.

Q.What are the major complications of HITHOC treatment?

Dr. Isik:  The major complication of HITHOC treatment is renal dysfunction and insufficiency. However, incidence of these entities is not high. Generally, we observe temporary renal dysfunction. It improves by hydration easily. Severe renal insufficiency is so rare, but it can be healed by renal dialysis. The incidences are 7% and 1% respectively for renal dysfunction and insufficiency in our series.

Q. What is the success rate of this treatment?

Dr. Isik:  In literature, the success rate is qualified according to survival rates. It has been observed that patients with pleural carcinoma have better survival with radical surgery plus HITHOC than the others significantly (Mean survival 27-35 months with HITHOC and 6-9 months without, respectively).  These patients have the chance of 5 year survival and cure.

Q. Are there any scientific research or evidence for HITHOC? What are the results of those studies?

Both malignant mesothelioma and other secondary pleural cancers have been studied for better survival. As a primary cancer of pleura Malignant Mesothelioma is the most studied subject. Recently, approximately for 15 years most of thoracic surgeons gave up extra pleural pneumonectomy (EPP) because of its morbidity and mortality despite poor prognosis. Radical pleurectomy and decortication with hyperthermic perfusion chemotherapy have been performed instead of EPP. We observed that better comfort and better survival were obtained such as 32-55 months mean survival and 20-25 % five year survival.

Hyperthermic perfusion chemotherapy of pleural space give us a chance for radical solutions of other pleural cancers. Lung cancer is the most seen cancer metastasis pleura. Pleural seeding or metastasis gets the stage to 4 with M1a disease. If patient has no other distant metastasis, we can perform radical surgery for lung cancer plus pleurectomy/decortication and hyperthermic perfusion chemotherapy.

There are many scientific researches about hyperthermic intracavitary chemotherapy for both mesothelioma and other secondary pleural cancers such as lung cancer, breast and over cancers etc.. [Ed. Note. For ease of reading, these references have been placed at the end of the interview].

Dr. Elbeyli and Dr. Isik (right) with APN staff (middle)

 

Q. What are the expected survival rates for patients who undergo HITHOC treatment?

Dr. Isik:   According to literature, radical pleurectomy and adjuvant HITHOC have 28-57 months mean survival. And also have more comfort after surgery and during the treatment period because of lacking pleural effusion recurrence. Five year survival rates are 20-35% for malignant pleural mesothelioma. However we perform radical surgery in patients with M1a lung cancer (Pleural metastatic lung cancer) and other secondary pleural cancers due to such as breast cancer, colon cancer over carcinoma etc. also. In M1a lung cancer cases, we obtain 20-25% 5 year survival where as 6-9 months in patients non-surgery groups. This is significant difference.

Q. Who is eligible for HITHOC treatment?

Dr. Isik:  HITHOC after radical surgery for pleural cancers can be performed in patients that have suitable baseline health and limited disease in the hemithorax.  Patients need to be strong enough for surgery and have the types of cancers that respond to this treatment.

HITHOC has been used to treat: Pleural cancers including malignant pleural mesothelioma, M1a Lung cancer with pleural seeding or metastases,  and other metastatic pleural cancers like breast, colon over  etc carcinomas.

Q. How do you know if patient’s are well enough for surgery?

Dr. Isik:  We evaluate their medical condition/ baseline health with detailed cardiac and respiratory examinations.  Patients need respiratory function tests includes spirometry, to be able to walk 600 meters and climbing 4 flights of stairs. Electrocardiogram and echocardiography if needed are performed by cardiology specialists to understand if patients have any cardiac problem.

For more on HITHOC

Scientific literature and research related to HITHOC:

  1. Giovanella BC, Morgan AC, Stehlin JS, Williams LJ. Selective lethal effect of supranormal temperatures on mouse sarcoma cells. Cancer Res 1973;33: 2568-2578.
  2. Giovanella BC, Stehlin JS, Shepard RC, Williams LJ. Hyperthermic treatment of human tumors heterotransplanted in nude mice. Cancer Res 1979;39: 2236-2241.
  3. Işık AF, Sanlı M, Yılmaz M, Meteroğlu F, Dikensoy O, Sevinç A, Camcı C, Tunçözgür B, Elbeyli L. Intrapleural hyperthermic perfusion chemotherapy in subjects with metastatic pleural malignancies. Respir Med 2013;107: 762-767.
  4. LangLazdunski L, Bille A, Papa S, Marshall S, Lal R, Galeone C, Landau D, Steele J, Spicer J. Pleurectomy/decortication, hyperthermic pleural lavage with povidoneiodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10 year experience. J Thorac Cardiovasc Surg 2015;149: 558-565; discussion 565-556.
  5. Li Q, Sun W, Yuan D, Lv T, Yin J, Cao E, Xiao X, Song Y. Efficacy and safety of recombinant human tumor necrosis factor application for the treatment of malignant pleural effusion caused by lung cancer. Thorac Cancer 2016;7: 136-139.
  6. Lombardi G, Nicoletto MO, Gusella M, Fiduccia P, Dalla Palma M, Zuin A, Fiore D, Donach M, Zagonel V. Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis. Cancer Chemother Pharmacol 2012;69: 781-787.
  7. Migliore M, Calvo D, Criscione A, Viola C, Privitera G, Spatola C, Parra HS, Palmucci S, Ciancio N, Caltabiano R, Di Maria G. Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience. Future Oncol 2015;11: 47-52.
  8. Mujoomdar AA, Sugarbaker DJ. Hyperthermic chemoperfusion for the treatment of malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg 2008;20: 298- 304.
  9. Richards WG, Zellos L, Bueno R, Jaklitsch MT, Jänne PA, Chirieac LR, Yeap BY, Dekkers RJ, Hartigan PM, Capalbo L, Sugarbaker DJ. Phase I to II study of pleurectomy/decortication and intraoperative intracavitary hyperthermic cisplatin lavage for mesothelioma. J Clin Oncol 2006;24: 1561-1567.
  10. Işık AF, Şanlı M, Dikensoy Ö, Aytekin İ, Benli Y, Sevinç A, Camcı C, Tunçözgür B, Elbeyli L. Can hyperthermic intrathoracic perfusion chemotherapy added to lung sparing surgery be the solution for malignant pleural mesothelioma? Turk Gogus Kalp Dama 2016;24:325-332
  11. Ried M, Potzger T, Braune N, Neu R, Zausig Y, Schalke B, Diez C, Hofmann HS. Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience. Eur J Cardiothorac Surg 2013;43: 801-807.
  12. Sugarbaker DJ, Gill RR, Yeap BY, Wolf AS, DaSilva MC, Baldini EH, Bueno R, Richards WG. Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection. J Thorac Cardiovasc Surg 2013;145: 955-963.
  13. Tilleman TR, Richards WG, Zellos L, Johnson BE, Jaklitsch MT, Mueller J, Yeap BY, Mujoomdar AA, Ducko CT, Bueno R, Sugarbaker DJ. Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg 2009;138: 405-411.
  14. Zellos L, Richards WG, Capalbo L, Jaklitsch MT, Chirieac LR, Johnson BE, Bueno R, Sugarbaker DJ. A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2009;137: 453-458.
  15. Zhou H, Wu W, Tang X, Zhou J, Shen H. Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion. Medicine 2017; 96: 1

All photos were taken during a site visit.

by

Cancer knows no language

Treatment of malignant pleural mesothelioma (MPM) with HITHOC

One of our exclusive network surgeons, Dr. Isik has produced a new video explaining HITHOC treatment in detail for our clients.  While many people may be frightened or worried to seek treatment in another country, particularly with a surgeon who speaks another language, Dr. Isik specializes in offering hope against these aggressive forms of cancer including Malignant pleural mesothelioma.

Malignant Mesothelioma & HITHOC

Malignant mesothelioma, which is devastating diagnosis carries a dismal prognosis without aggressive, multi-modal treatment.  The majority of malignant mesothelioma affects the pleura (or the lining around the lung).  This cancer is often associated with exposure to asbestos.

There is another form of mesothelioma which affects the abdomen.  This is best treated with a related procedure called HIPEC.  Click here to learn more about HIPEC treatment with the affiliated providers of American Physicians Network.

In the video below, Dr. Isik explains, in detail, about hyperthermic intra-thoracic chemotherapy, better known as HITHOC, and it’s use in treatment of malignant pleural mesothelioma.

Warning:  The enclosed video has graphic content.

Not just for mesothlioma

HITHOC is also used for the treatment of advanced thymomas, treatment of malignant pleural effusions (from some advanced lung and other cancers).  Dr. Isik is one of our network surgeons that performs this procedure.  He is fluent in English as well, and is currently completing a new video in English for our clients.  (Each program has it’s own inclusion criteria, please contact APN for more information).

by

APN announces a special escorted trip for December 2019

 

American Physicians Network is offering their first escorted trip for interested clients.  Our destination for this trip will be to Colombia.  For this escorted trip, clients can travel and undergo consultations and surgery with many of our Colombian based network providers in a trip arranged and escorted by the American Physicians Executive board.

This will allow clients to explore their health travel options while accompanied by our knowledgeable staff.  Clients will be able to have consultations with a surgeon for their desired procedure and undergo surgical procedures and diagnostic testing with an APN representative escort.  Clients seeking Executive Physicals are also welcome.

This trip is perfect for clients who need several months advance notice (for either financial, work or other responsibilities), solo travelers, first-time international travelers, and clients who simply would prefer a more elevated level of service for their health travel.

This trip will include sight-seeing, hotel accommodations and a surgical consultation (if desired) in the specialty of their choice.  Costs will be based on the class of accommodations and the cost of surgical consultation and/or surgery.  Meals and local transportation for additional activities are not included but an estimate of these costs will be provided to interested clients.

This trip is tentatively planned for the end of November – early December.  APN is only accepting a limited number of clients for this trip.

Have any questions?  Contact our knowledgeable staff.

Ready to sign up?

Reserve your place for the low cost of $125.00.  Participants who sign up before September 1st, 2019 will receive any early bird discounted reservation rate of $75.00

Additional escorted trips may be scheduled for other destinations in our network in the future.

 

 

by

APN adds the “masters of thoracic surgery” to our roster

After completing another trip around the world, interviewing, inspecting and observing surgeons, the American Physicians Network  is excited to announce the addition of several new network surgeons in the specialty of thoracic surgery.  We are particularly pleased to announce that we have added several of the ‘modern masters of thoracic surgery’ – who are among the acknowledged top thoracic surgeons in the world.  While these surgeons are new to APN, we have worked with all of these physicians in the past, and they were actively recruited for their surgical skills and advanced training in the area of thoracic surgery.

These surgeons are the very best, and most current in their field.  Each of these surgeons was hand-picked and recruited due to their extensive experience in their respective areas; whether it is expertise in minimally invasive techniques such as uniportal VATS, subxifoid approaches to reduce pain, disability and recovery time or other specialty surgical treatments for various diseases of the lungs, pleural, mediastinum or thorax.  One of our surgeons was recruited to provide patients with an additional facility for HITHOC.  (This is the second HITHOC surgeon in our current roster).

This group of immensely talented and skilled thoracic surgeons is a roll-call of the best and brightest, and includes the inventor of uniportal thoracic surgery, Dr. Diego Gonzalez Rivas, Hong Kong legend, Dr. Alan Sihoe, HITHOC researcher, Dr. Hans – Stefan Hofmann and the founder of International VATS, Dr. Marco Scarci.  APN will bring you more information about these and many of our other network providers in the future.

with Dr. Hofmann outside the operating room after another successful case

All of these surgeons are able to provide world-class care at a fraction of the cost of US-based treatment.  Each of these surgeons has undergone an extensive vetting process which includes direct observation in the operating room.

by

International VATS 2018: Better than before – Extreme Fast track thoracic surgery

Thoracic Surgery posted “International VATS 2018: Better than before – Extreme Fast track thoracic surgery” by Kristin Eckland.

Some of the videos are silly, cheesy even…  But ugly track suits aside…

The results are, in arguably, wonderful.  Patients eating, drinking, walking, and relaxing just an hour after major lung surgery.

Dr. Joao Carlos Das Neves Pereira is a Brazilian thoracic surgeon, who has been the primary author and leader on several articles, and programs for what he is calling ‘extreme fast track thoracic surgery’.   He was also one of the featured speakers at International VATS 2018.  “Better than before” is his model.  “Patient empowerment’ is his ideology.

His presentation was easily the best in show, so to speak.. What’s more remarkable about his results are – that this isn’t new.  He’s been doing it for more than a decade.  In fact, he published an article on his experience in the European Journal of cardio-thoracic surgery was back in 2009.  And now he is responsible for the implementation of a multi-disciplinary program at two hospitals on two continents – one on Paris, France and the second in Sao Paulo, Brazil.

So what does he do?  How does he do it?  And why aren’t the rest of us doing it?

What he does:  “Feed & walk”

Change the existing surgical traditions:

  • no prolonged fasting
  • no cold operating rooms
  • no IV opioids

He does this with a multifaceted program that starts several weeks before surgery; with a comprehensive nutrition, smoking cessation and and an exercise regimen.

The night before:

  • Aromatherapy with lavender / Orange to promote sleep.
  • Avoid benzodiazepines

On the morning of surgery

  • patients are able to drink liquids within two hours of surgery, preventing dehydration and eliminating the need for IV fluids (no starving!)

During surgery

  • Normothermia
  • Multi-modality approach for anxiety/ nausea/ vomiting / pain
  • Opioid-free

Patient analgesia and anesthetic is treated with a combination of approaches including hypnosis, pre-emptive oral medications, BIS for awake anesthesia, minimally invasive airways.  Patients are only given very short acting medications such as ketamine, or propofol combined with local anesthesia.  By avoiding narcotics, there is a reduction in both sedation, and GI complications post-operatively.

Patients who are able to readily wake up after surgery and who haven’t had narcotics that adversely affect bowel function) are able to eat and drink immediately after surgery.

Post-operative

  • Immediate extubation (once the specimen is out of the chest)
  • Immediate feeding
  • Immediate exercise
  • “Hands free” care:  No IV lines, oral medications only, patient controlled and opioid free.

Patients are encouraged to wear their own clothing before going to the exercise room, the outside garden or walking the halls.  Post-operative pain management consists of oral medications only, and is augmented by physical therapy, acupuncture, aromatherapy and massage.  Friends and family are instructed in the proper massage techniques so that they are able to participate in the patients care (also shortage of massage therapists).  Patient recovery is enhanced by conviviality: patients don’t spend time in the rooms, alone or in bed.  Patients are welcome to spend time in open spaces, aromatherapy areas, exercise rooms, a japanese style garden, an indoor garden and a tea room.  Patients are encouraged to socialize and spend time with other patients.

While some of these ideas are novel, there is no magic surgical technique, and no miracle drug to account for these results – which are arguably better the most of ours.  But it’s not just aromatherapy, it’s a philosophy of care.

More importantly, what Dr. Das Neves Pereira and his colleagues have; that many of us find difficult to replicate – is patient buy-in.   We can call it “Patient empowerment” but it’s the part that many of us continue to struggle with.

But Dr. Das Neves Pereira’s lecture leaves us with more questions as well as answers..

Would this work for your practice?  And why aren’t the rest of us already doing it?  Will the patients accept it?

For the answer to this – we have to look at our own practices, in the here and now, in late 2018.    A recent issue of the thoracic journal of disease did just that, devoting an entire issue to ERAS (enhanced recovery and fast track programs) while providing blueprints for anesthesiologists, nursing and physical therapists.  But for many of us, the pat and simple answer is something like this:

“While most of my patients wouldn’t mind some aromatherapy or a massage after surgery, the unfortunate truth is that few would participate in a pre-operative program stressing diet and exercise.  Even fewer patients would sign on for a program that restricts narcotics.  Many of us already know this about our patient populations because we try routinely to incorporate more holistic practices into our treatment in a daily basis.  While holistic premises and alternative treatments make billions of dollars in the United States (under the guise of prevention) it’s still a culture that is highly dependent on fast, and immediate remedies and a strong belief that very little post-operative pain is acceptable or tolerable.  For every one patient that would embrace the philosophies of extreme rehabilitation, there would be another 200 screaming at the nurses for IV dilaudid.”

Much of the research actually confirms this view:

British researchers, Rogers et al. (2018) had a similar experience, noting in their recent publication that benefits of enhanced recovery protocols were dependent on compliance (and adherence) to protocols – particularly in regards to pre-operative dietary modification, and early post-operative ambulation.  Refai et al. (2018) have attempted to address these issues with a comprehensive patient education component. However, their publication does not address whether these interventions increased compliance and reduced patient stress or anxiety.

Does this mean that we are skeptical of extreme rehab – no, not at all!  Interest, participation and development in fast track thoracic surgery programs continues to grow despite these obstacles.

In fact, the tightening of many federal and state restrictions on narcotics due to the American opioid crisis may make this the best time in modern American medical history to bring this ideas and approaches to our patients (Bruera & Del Fabbio, 2018, Herzid, 2018).   It also means that many of us have some preliminary hurdles and preconceived notions  (on all sides)  to overcome to engage our patients, nurses, therapists and fellow medical professionals to get their buy-in on the idea.  We might be over a decade behind – but it’s not too late to start today.

References:

Das-Neves-Pereira, et al. 2009).  Fast track rehabilitation for lung cancer lobectomy: a five year experience.  European Journal of Cardio-thoracic surgery, 36 (2009) 838-392. primary reference article.

Additional References:

Bruera, E. & Del Fabbio, E. (2018). Pain management in the era of the opioid crisis.  Am Soc Clin Oncol Educ Book 2018 May 23 (38): 807-812.

D’Andrilli, A. & Rendina, E. (2018). Enhanced recovery after surgery and fast-track in video-assisted thoracic surgery lobectomy: preoperative optimisation and care-plans.  Journal of visualized surgery, 2018:4 (4).

Herzid, S. (2018). Annals for hospitalists Inpatient Notes: Managing acute pain in the hospital in the face of the opioid crisis.  Annals of internal medicine 169(6): H02-H03.

Rogers, et. al (2018).  The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer.  Journal of thoracic and cardiovascular surgery.  155(4) April 2018: 1843 -1852.

European Society of Anaesthesiology. “Hypnosis/local anesthesia combination during surgery helps patients, reduces hospital stays, study finds.” ScienceDaily. ScienceDaily, 21 June 2011.

From the Journal of thoracic disease – special issue:  Supplemental issue #4 2018

Ardo et. al. (2018). Enhanced recovery pathways in thoracic surgery.

Bertani et al. (2018). A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video assisted thoracoscopic surgery: lobectomy.

Picconi, et. al. (2018). Enhanced recovery pathways in thoracic surgery from Italian VATS group: perioperative analgesic protocols. 

Refai et. al. (2018). Enhanced recovery after thoracic surgery: patient information and care-plans.

Request a FREE Preliminary Patient Consultation online!