Jay Weiner’s cardiologist called with good news and bad news. The good news: Weiner’s six coronary stent grafts all looked fine, as did the results from his cardiac stress tests. The 73-year-old retired dental-supply executive savored a moment of relief. Then came the bad news: Weiner’s CT images seemed to indicate a spot on his left lung. To follow up, he would need a PET scan, as well.
Terrified, Weiner drove to his local hospital in New Jersey. The new scan confirmed the presence of a lesion about the width of a nickel on the upper lobe—given his history of heavy smoking, the cardiologist warned, a probable cancer. “I called a friend who’s a rep for a drug company, and said, ‘If you could choose any hospital in the country, where would you have this treated?’” he recalls. The friend recommended Perlmutter Cancer Center at NYU Langone Health, recently designated a Comprehensive Cancer Center, the highest ranking awarded by the National Cancer Institute. Its record of excellence in the past 5 years includes the recruitment of more than 20 nationally renowned faculty members, a 110 percent increase in new patients, and a doubling of patients enrolled in clinical trials.
Weiner met with Abraham Chachoua, MD, the Jay and Isabel Fine Professor of Oncology and chief of medical oncology, who referred him to Harvey Pass, MD, the Stephen E. Banner Professor of Thoracic Oncology and chief of thoracic surgery, for further evaluation. Because symptoms of lung cancer seldom arise before the disease advances, 70 percent of cases go undiagnosed until stage III or IV. So in a way, Dr. Pass told Weiner, he was fortunate: if he did have lung cancer, it had been caught early, when survival rates are relatively good. But how to proceed was far from obvious.
“This was one case where I wanted to get the advice of my colleagues,” Dr. Pass says. He discussed the complexities with other specialists at that week’s multidisciplinary lung meeting. One of the patient’s stents had been implanted just two months earlier, making surgery, which would require him to go off his blood thinner, unusually risky. Adding to that concern was the fact that he’d already had three heart attacks. Yet the tumor was too close to his heart to be safely treated with radiation therapy. Because the mass was growing rapidly, waiting would be dangerous, as well. After weighing all these factors, plus Weiner’s physical vigor and acceptable pulmonary function, the group concluded that moving ahead with surgery was the best option.
Weiner agreed. On April 9, 2018, he was wheeled into an operating room (OR) on the sixth floor of Tisch Hospital. Dr. Pass planned to perform a minimally invasive procedure, inserting a tiny video camera and surgical tools through two small incisions. For better access, he propped Weiner on his side on the OR bed. As he pierced the ribcage, however, a dreaded signal appeared on the vital signs monitor: ventricular fibrillation. The patient was going into cardiac arrest.
To save his life, the team had to act fast. Dr. Pass lengthened the incision and cut the tissue between two ribs. Reaching into the chest, he opened the heart sac. Then, he began manually pumping Weiner’s heart to keep blood flowing to his brain—a task made more challenging by the patient’s position. Meanwhile, the anesthesiologist poured medications into Weiner’s veins to try to restore a heartbeat. Grabbing a set of defibrillator paddles, Dr. Pass delivered a shock to the quivering organ. It didn’t work, but he kept trying, applying the paddles seven times between rounds of cardiac massage. To ensure adequate blood pressure, he kept close watch on the monitor as he worked. Finally, after a harrowing 25 minutes, Weiner’s heart began beating on its own.
The next step was to determine whether the cancer surgery could continue. The team wheeled Weiner across the hall to one of NYU Langone’s two state-of-the-art hybrid operating rooms, designed to accommodate both open surgery and catheter-based procedures. There, they were joined by Mathew R. Williams, MD, chief of adult cardiac surgery and director of the Heart Valve Center—the first surgeon in the United States to be dual-trained in interventional cardiology and cardiac surgery, and one of the country’s leading practitioners in both disciplines. “It’s a tremendous asset to have him available at a moment’s notice,” says Dr. Pass.
Dr. Williams performed an angiogram, which showed that the arteries were clear. If the fibrillation had resulted from a blood clot, he surmised, the cardiac massage might have flushed it out. Still, he suggested, the safest option from a cardiovascular standpoint was to give Weiner a large dose of anticoagulants, which would preclude completing the operation.
Dr. Pass faced another stark dilemma. He knew it would be risky to keep Weiner off blood thinners long enough to finish the surgery. But operating later was out of the question. “We couldn’t put the patient through that trauma twice,” he says. If he left the tumor, it would likely spread and become incurable. Did the possibility of prolonging Weiner’s life—and sparing him the ordeal of chemotherapy—justify taking one more chance? Dr. Pass’s decision was based on long experience. In the hybrid OR, he uncovered the incision and excised the lesion (which lab tests later showed was malignant), along with a wedge of lung surrounding it.
Dr. Pass faced another stark dilemma. He knew that finishing the surgery would be risky. But trying again later was out of the question. “We couldn’t put the patient through that trauma twice,” he says. If he didn’t remove the tumor now, it would likely spread and become incurable.
When Weiner woke up in the cardiac intensive care unit, he learned that his surgery had been somewhat more eventful than expected. Remarkably, tests showed no cognitive deficits or cardiac damage; his brain and heart had been deprived of oxygen only briefly before Dr. Pass began pumping. He received an implantable defibrillator four days after the operation. Three days after that, he returned home, and soon he was back to playing with his grandchildren.
Weiner wasn’t quite out of the woods yet: in August, a CT scan turned up another tumor on the same lung. This time, though, it could be treated without surgery. Benjamin Cooper, MD, director of photon therapy services in the Department of Radiation Oncology, administered stereotactic body radiation therapy, which delivers precise, focused beams that spare surrounding tissue. After 10 sessions, Weiner was declared cancer-free.
“I can’t rave enough about the doctors and staff at Perlmutter,” he says. “And I would lay down my life for Dr. Pass. As far as I’m concerned, he’s a gift from God.”
To Dr. Chachoua, this case illustrates the advantages of treatment at an academic medical center, where, when things go wrong in complex ways, top specialists from diverse fields join together to set them right. “If Jay hadn’t had access to the highest level of care, he probably wouldn’t have survived,” he says. “This is what NYU Langone does best.”