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Holy Grail of Thoracic Surgery
August 26, 2010   
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Physicians from across the world flock to the Polish mountain resort of Zakopane to learn an innovative lung cancer staging method developed by Dr. Marcin Zieliński, a surgeon and director of the town’s Specialist Pulmonary Hospital.

Zieliński says his method, developed six years ago, is the least invasive of all methods of this kind developed so far. It is also the most accurate one, according to the surgeon. It makes it possible to determine if a patient would actually benefit from having a lung tumor removed surgically.

The method has attracted interest from other medical centers in Poland—in the cities of Cracow, Szczecin and Rzeszów—but first physicians from abroad started to come to Zakopane to learn how to use it, Zieliński says. He has performed a series of diagnostic procedures using his method abroad. Called Transcervical Extended Mediastinal Lymphadenectomy (TEMLA), the method involves removing lymph nodes from the chest through a small incision in the neck.

The lymph nodes are essential in diagnosing the stage of lung cancer because they are usually the first place to which the cancer spreads. By examining the removed organs under a microscope, one is able to determine whether or not they contain cancer cells. This helps make a decision about further treatment. If the cancer has already spread to the lymph nodes an operation to remove the lung tumor will not be very helpful, Zieliński says; it might even result in a deterioration of the patient’s health. But if the cancer has not spread to the nodes an operation offers a chance for the patient to recover.

TEMLA vs. mediastinoscopy

What is innovative about the TEMLA method is that it involves dissecting whole lymph nodes rather than only small portions of them as is done when the conventional diagnostic method called mediastinoscopy is used. Mediastinoscopy is not always reliable because the dissected lymph node fragments may be free from cancer cells, although the cancer has already spread to the nodes. The results of other methods used to diagnose cancer—CAT scans and endoscopic ultrasound—are equally inaccurate. With Zieliński’s method, if no cancer cells are found in the removed lymph nodes there is 98 percent certainty that the cancer has not metastasized and that an operation can benefit the patient. The method can also be used to check the results of previous medical examinations if they indicate that the cancer has not spread.

The method was developed by Zieliński as he treated patients with myasthenia, a disease triggered by a thymus disorder. The treatment included the removal of the thymus, an organ located in the mediastinum. Zieliński accessed the organ through the neck and this is how he hit upon the idea that lymph nodes could be removed in the same way. But to do so he needed a suitable instrument, which only had to be developed. The prototype, designed by Zieliński, was made at the Zakopane hospital. Instruments based on this prototype are now manufactured by an international company specialized in the production of surgical instruments.

Gold standard

A growing number of surgeons are eager to use the TEMLA method, according to Zieliński. Dozens of specialists from across the world, including those from reputable American teaching hospitals, have come to Zakopane to learn the technique. Zieliński was invited to deliver a lecture about TEMLA at a convention of the American Association for Thoracic Surgery. In March, he spent two weeks with his team in Sao Paulo, Brazil, where he taught his method to more than 80 surgeons from South America. He is still receiving invitations from other medical centers, mainly in Europe and America, but also from countries such as Jordan.

The method has been widely described in medical journals. Outstanding Belgian thoracic surgeon Paul E. van Schil has written that TEMLA is the most accurate method for evaluating mediastinum and should be regarded as the “gold standard” in the field. Van Schil has called Zieliński’s discovery “the Holy Grail of thoracic surgery.”
Ewa Dereń
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