Thoracic & Cardiovascular Surgery
Ara Vaporciyan, M.D.
Department Chair
The Thoracic and Cardiovascular Surgery department at MD Anderson Cancer Center, located in Houston, primarily treats all cancers within the chest. These include:
- Lung cancer
- Esophageal cancer
- Mesothelioma
- Mediastinal tumors
- Cancers of the chest wall
- Cancers of major blood vessels
- Cancers that originates in or invade the heart
- Cancers that spread to the lungs
Efforts are directed at improving treatment results by utilizing minimally invasive techniques, enhanced recovery, opiod avoidance and combining surgery with chemotherapy, immunotherapy or targeted therapies, and radiation therapy.
The department uses novel surgical techniques to ensure the best results for patients.
Novel thoracic surgery and cardiovascular surgery techniques
- Minimally invasive surgery (thoracoscopic and robotic surgery)
- Organ-sparing resections (lung segmental and sleeve operations; esophageal endoscopic mucosal resection)
- Endobronchial and esophageal ultrasound for cancer staging
- Pancoast tumor resection with or without vertebrectomy
- Complex chest wall resection and reconstruction
- Jejunal and colonic interposition for esophageal reconstruction
- Heated intraoperative chemoperfusion for pleural cancers
Conventional thoracic surgery and cardiovascular surgery techniques
- Wedge resection
- Segmentectomy or segmental resection
- Lobectomy
- Pneumonectomy
- Esophagectomy
The department has a team of surgeons and researchers. They provide complete care to patients in the Thoracic Center at MD Anderson and at MD Anderson in West Houston, Sugar Land, League City and The Woodlands. See below for a glimpse of Thoracic and Cardiovascular Surgery volumes.
Thoracic Surgery and Cardiovascular Surgery Volumes
Thoracic Surgery & Cardiovascular Surgery Programs
Lung Cancer Screening Program
The department hosts an active Lung Cancer Screening Program for current and former smokers to help detect lung cancer at its earliest stage, when treatment is most effective.
Vascular Surgery Program
The Vascular Surgery Program provides diagnostic evaluation, medical, endovascular and operative care to cancer patients and survivors with various forms of vascular disease.
Minimally Invasive Surgery Program
The department's robust minimally invasive surgery program is focused on reducing the pain and trauma associated with conventional open surgery. The program routinely performs video-assisted thoracic surgery (VATS) and robotic-assisted surgery for lung, thymic and esophageal cancers. Approximately 80% of early stage lung cancer is resected using minimally invasive techniques. A recent review of nearly 1,000 MD Anderson cases revealed that these techniques cut in half the number of postoperative complications. Minimally invasive surgery is also part of the department's enhanced recovery pathway. Read more about the program in the publications listed below.
- Leitao MM Jr, Kreaden US, Laudone V, Park BJ, Pappou EP, Davis JW, Rice DC, Chang GJ, Rossi EC, Hebert AE, Slee A, Gonen M. The RECOURSE Study: Long-term Oncologic Outcomes Associated With Robotically Assisted Minimally Invasive Procedures for Endometrial, Cervical, Colorectal, Lung, or Prostate Cancer: A Systematic Review and Meta-analysis. Ann Surg. 2023 Mar 1;277(3):387-396. doi: 10.1097/SLA.0000000000005698. Epub 2022 Sep 8. PMID: 36073772. PMCID: PMC9905254.
- Kent MS, Hartwig MG, Vallières E, Abbas AE, Cerfolio RJ, Dylewski MR, Fabian T, Herrera LJ, Jett KG, Lazzaro RS, Meyers B, Mitzman BA, Reddy RM, Reed MF, Rice DC, Ross P, Sarkaria IS, Schumacher LY, Tisol WB, Wigle DA, Zervos M. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: An Analysis of 5721 Cases. Ann Surg. 2023 Mar 1;277(3):528-533. doi: 10.1097/SLA.0000000000005115. Epub 2021 Sep 16. PMID: 34534988. PMCID: PMC9891268.
- Kent MS, Hartwig MG, Vallières E, Abbas AE, Cerfolio RJ, Dylewski MR, Fabian T, Herrera LJ, Jett KG, Lazzaro RS, Meyers B, Reddy RM, Reed MF, Rice DC, Ross P, Sarkaria IS, Schumacher LY, Spier LN, Tisol WB, Wigle DA, Zervos M. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6646 Cases. Ann Surg. 2023 Jun 1;277(6):1002-1009. doi: 10.1097/SLA.0000000000005820. Epub 2023 Feb 10. PMID: 36762564.
- Zhou N, Corsini EM, Antonoff MB, Hofstetter WL, Mehran RJ, Rajaram R, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rice DC. Robotic Surgery and Anatomic Segmentectomy: An Analysis of Trends, Patient Selection, and Outcomes. Ann Thorac Surg. 2022 Mar;113(3):975-983. doi: 10.1016/j.athoracsur.2021.03.068. Epub 2021 Apr 7. PMID: 33838123.
- Jarocki A, Rice D, Kent M, Oh D, Lin J, Reddy RM. Validity of robotic simulation for high-stakes examination: a pilot study. J Robot Surg. 2022 Apr;16(2):409-413. doi: 10.1007/s11701-021-01258-9. Epub 2021 May 29. PMID: 34053018.
- Nguyen DM, Sarkaria IS, Song C, Reddy RM, Villamizar N, Herrera LJ, Shi L, Liu E, Rice D, Oh DS. Clinical and economic comparative effectiveness of robotic-assisted, video-assisted thoracoscopic, and open lobectomy. J Thorac Dis. 2020 Mar;12(3):296-306. doi: 10.21037/jtd.2020.01.40. PMID: 32274096. PMCID: PMC7139048.
- Nelson DB, Mehran RJ, Mitchell KG, Rajaram R, Correa AM, Bassett RL Jr, Antonoff MB, Hofstetter WL, Roth JA, Sepesi B, Swisher SG, Walsh GL, Vaporciyan AA, Rice DC. Robotic-Assisted Lobectomy for Non-Small Cell Lung Cancer: A Comprehensive Institutional Experience. Ann Thorac Surg. 2019 Aug;108(2):370-376. doi: 10.1016/j.athoracsur.2019.03.051. Epub 2019 Apr 18. PMID: 31004583.
- Nelson DB, Dhupar R, Katkhuda R, Correa A, Goltsov A, Maru D, Sepesi B, Antonoff MB, Mehran RJ, Rice DC, Vaporciyan AA, Davila M, Davila R, Betancourt S, Ajani J, Hofstetter WL. Outcomes after endoscopic mucosal resection or esophagectomy for submucosal esophageal adenocarcinoma. J Thorac Cardiovasc Surg. 2018 Jul;156(1):406-413.e3. doi: 10.1016/j.jtcvs.2018.02.093. Epub 2018 Mar 12. PMID: 29605441.
- Vial MR, O'Connell OJ, Grosu HB, Hernandez M, Noor L, Casal RF, Stewart J, Sarkiss M, Jimenez CA, Rice D, Mehran R, Ost DE, Eapen GA. Diagnostic performance of endobronchial ultrasound-guided mediastinal lymph node sampling in early stage non-small cell lung cancer: A prospective study. Respirology. 2018 Jan;23(1):76-81. doi: 10.1111/resp.13162. Epub 2017 Aug 30. PMID: 28857362. PMCID: PMC5711568.
- Vial MR, Khan KA, O'Connell O, Peng SA, Gomez DR, Chang JY, Rice DC, Mehran R, Jimenez CJ, Grosu HB, Ost DE, Eapen GA. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Nodal Staging of Stereotactic Ablative Body Radiotherapy Patients. Ann Thorac Surg. 2017 May;103(5):1600-1605. doi: 10.1016/j.athoracsur.2016.09.106. Epub 2016 Dec 24. PMID: 28027732. PMCID: PMC5401639.
- Stephens N, Rice D, Correa A, Hoffstetter W, Mehran R, Roth J, Walsh G, Vaporciyan A, Swisher S. Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-small-cell lung cancer: a propensity-matched analysis of 963 cases. Eur J Cardiothorac Surg. 2014 Oct;46(4):607-13. doi: 10.1093/ejcts/ezu036. Epub 2014 Mar 5. PMID: 24603446.
- Rice DC, Steliga MA, Stewart J, Eapen G, Jimenez CA, Lee JH, Hofstetter WL, Marom EM, Mehran RJ, Vaporciyan AA, Walsh GL, Swisher SG. Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma. Ann Thorac Surg. 2009 Sep;88(3):862-8; discussion 868-9. doi: 10.1016/j.athoracsur.2009.05.022. PMID: 19699913.
- Nelson DB, Mehran RJ, Mitchell KG, Rajaram R, Correa AM, Bassett RL Jr, Antonoff MB, Hofstetter WL, Roth JA, Sepesi B, Swisher SG, Walsh GL, Vaporciyan AA, Rice DC. Robotic-Assisted Lobectomy for Non-Small Cell Lung Cancer: A Comprehensive Institutional Experience. Ann Thorac Surg. 2019 Aug;108(2):370-376. doi: 10.1016/j.athoracsur.2019.03.051. Epub 2019 Apr 18. PubMed PMID: 31004583.
- Stephens N, Rice D, Correa A, Hoffstetter W, Mehran R, Roth J, Walsh G, Vaporciyan A, Swisher S. Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-small-cell lung cancer: a propensity-matched analysis of 963 cases. Eur J Cardiothorac Surg. 2014 Oct;46(4):607-13. doi: 10.1093/ejcts/ezu036. PubMed PMID: 24603446.
Enhanced Surgical Recovery Program
The Enhanced Surgical Recovery Program in Thoracic Surgery results in reduced symptoms, improved function and quicker return to normal activities and additional needed treatment. This program uses the principles of optimal perioperative care pathways as the foundation of their program. These principles include avoiding long periods of fasting, reducing patient anxiety through education and expectation setting, minimizing narcotic use and using goal-directed fluid therapy. Thoracic Surgery, in particular, has implemented elements such as preventive, multimodal and regional pain control, early ambulation and return to nutrition, modulation of inflammation and prevention of post-operative nausea. Read more about the program in the Enhanced Recovery Program Fiscal Year 2019 Annual Report and in the recent publications below.
- Nelson DB, Mehran RJ, Mena GE, Hofstetter WL, Vaporciyan AA, Antonoff MB, Rice DC. Enhanced recovery after surgery improves postdischarge recovery after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2023 May;165(5):1731-1740.e5. doi: 10.1016/j.jtcvs.2022.09.064. Epub 2022 Oct 26. PMID: 36404141.
- Zhou N, Niu J, Nelson D, Feldman HA, Antonoff MB, Hofstetter WL, Mehran RJ, Rice DC, Sepesi B, Swisher SG, Walsh GL, Giordano SH, Rajaram R. Surgical Approach and Persistent Opioid Use in Medicare Patients Undergoing Lung Cancer Resection. Ann Thorac Surg. 2023 Nov;116(5):1020-1027. doi: 10.1016/j.athoracsur.2023.02.013. Epub 2023 Feb 16. PMID: 36801207.
- Zorrilla-Vaca A, Feldman H, Antonoff M, Sepesi B, Hofstetter W, Rajaram R, Swisher S, Mena G, Vaporciya A, Mehran R, Rice D. Single Chest Drain Practice Reduces Discharge Opioid Prescriptions in Thoracic Surgery. Thorac Cardiovasc Surg. 2022 Aug;70(5):422-429. doi: 10.1055/s-0041-1740322. Epub 2021 Dec 11. PMID: 34894636.
- Zorrilla-Vaca A, Rice D, Brown JK, Antonoff M, Sepesi B, Hofstetter W, Swisher S, Walsh G, Vaporciyan A, Mehran R, Hagberg C, Mena GE. Sustained reduction of discharge opioid prescriptions in an enhanced recovery after thoracic surgery program: A multilevel generalized linear model. Surgery. 2022 Feb;171(2):504-510. doi: 10.1016/j.surg.2021.08.039. Epub 2021 Nov 2. PMID: 34740455.
- Mena GE, Zorrilla-Vaca A, Vaporciyan A, Mehran R, Lasala JD, Williams W, Patel C, Woodward T, Kruse B, Joshi G, Rice D. Intraoperative Dexmedetomidine and Ketamine Infusions in an Enhanced Recovery After Thoracic Surgery Program: A Propensity Score Matched Analysis. J Cardiothorac Vasc Anesth. 2022 Apr;36(4):1064-1072. doi: 10.1053/j.jvca.2021.09.038. Epub 2021 Sep 27. PMID: 34690059.
- Rajaram R, Rice DC, Li Y, Bruera E, Liu E, Song C, Oh DS. Postoperative opioid use after lobectomy for primary lung cancer: A propensity-matched analysis of Premier hospital data. J Thorac Cardiovasc Surg. 2021 Jul;162(1):259-268.e4. doi: 10.1016/j.jtcvs.2020.04.148. Epub 2020 May 16. PMID: 32718706.
- Blumenthaler AN, Zhou N, Parikh K, Hofstetter WL, Mehran RJ, Rajaram R, Rice DC, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB. Optimizing Discharge After Shorter Hospitalizations: Lessons Learned Through After-Hours Calls with Thoracic Surgical Patients. Innovations (Phila). 2021 Nov-Dec;16(6):529-535. doi: 10.1177/15569845211041343. Epub 2021 Sep 8. PMID: 34494925.
- Corsini EM, Mitchell KG, Zhou N, Antonoff MB, Mehran RJ, Mena GE, Rajaram R, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rice DC, Hofstetter WL. Liposomal Bupivacaine Intercostal Block Is Important for Reduction of Pulmonary Complications. Ann Thorac Surg. 2021 Aug;112(2):423-429. doi: 10.1016/j.athoracsur.2020.09.017. Epub 2020 Oct 28. PMID: 33129774.
- Nelson DB, Niu J, Mitchell KG, Antonoff MB, Giordano SH, Hofstetter WL, Vaporciyan AA, Sepesi B, Mehran RJ, Rice DC. Perioperative outcomes among chronic opioid users who receive lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2020 Feb;159(2):691-702.e5. doi: 10.1016/j.jtcvs.2019.09.059. Epub 2019 Sep 27. PMID: 33003262.
- Van Haren RM, Correa AM, Sepesi B, Rice DC, Hofstetter WL, Roth JA, Swisher SG, Walsh GL, Vaporciyan AA, Mehran RJ, Antonoff MB. Hospital readmissions after pulmonary resection: post-discharge nursing telephone assessment identifies high risk patients. J Thorac Dis. 2020 Mar;12(3):184-190. doi: 10.21037/jtd.2020.02.08. PMID: 32274083. PMCID: PMC7139035.
- Nelson DB, Niu J, Mitchell KG, Sepesi B, Hofstetter WL, Antonoff MB, Giordano SH, Mehran RJ, Rice DC. Persistent Opioid Use Among The Elderly After Lung Resection: A SEER-Medicare Study. Ann Thorac Surg. 2019 Aug 22. pii: S0003-4975(19)31216-0. doi: 10.1016/j.athoracsur.2019.06.095. [Epub ahead of print] PubMed PMID: 31445908.
- Nelson DB, Cata JP, Niu J, Mitchell KG, Vaporciyan AA, Antonoff MB, Hofstetter WL, Giordano SH, Sepesi B, Mehran RJ, Rice DC. Persistent opioid use is associated with worse survival after lobectomy for stage I non-small cell lung cancer. Pain. 2019 Oct;160(10):2365-2373. doi: 10.1097/j.pain.0000000000001630. Pubmed PMID: 31149979.
- Nelson DB, Mehran RJ, Mitchell KG, Correa AM, Sepesi B, Antonoff MB, Rice DC. Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019 Jul;158(1):279-286.e1. doi: 10.1016/j.jtcvs.2019.03.009. Epub 2019 Mar 21. PubMed PMID: 31014665.
- Marcus RK, Lillemoe HA, Rice DC, Mena G, Bednarski BK, Speer BB, Ramirez PT, Lasala JD, Navai N, Williams WH, Kim BJ, Voss RK, Gottumukkala VN, Aloia TA. Determining the Safety and Efficacy of Enhanced Recovery Protocols in Major Oncologic Surgery: An Institutional NSQIP Analysis. Ann Surg Oncol. 2019 Mar;26(3):782-790. doi: 10.1245/s10434-018-07150-5. Epub 2019 Jan 9. PubMed PMID: 30627879.
- Van Haren RM, Mehran RJ, Mena GE, Correa AM, Antonoff MB, Baker CM, Woodard TC, Hofstetter WL, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rice DC. Enhanced Recovery Decreases Pulmonary and Cardiac Complications After Thoracotomy for Lung Cancer. Ann Thorac Surg. 2018 Jul;106(1):272-279. doi: 10.1016/j.athoracsur.2018.01.088. Epub 2018 Mar 9. PubMed PMID: 29530770.
- Mehran RJ, Martin LW, Baker CM, Mena GE, Rice DC. Pain Management in an Enhanced Recovery Pathway After Thoracic Surgical Procedures. Ann Thorac Surg. 2016 Dec;102(6):e595-e596. doi: 10.1016/j.athoracsur.2016.05.050. PubMed PMID: 27847094.
- Mehran RJ, Walsh GL, Zalpour A, Cata JP, Correa AM, Antonoff MB, Rice DC. Intercostal Nerve Blocks With Liposomal Bupivacaine: Demonstration of Safety, and Potential Benefits. Semin Thorac Cardiovasc Surg. 2017 Winter;29(4):531-537. doi: 10.1053/j.semtcvs.2017.06.004. Epub 2017 Jun 6. PubMed PMID: 29698654.
- Shi Q, Wang XS, Vaporciyan AA, Rice DC, Popat KU, Cleeland CS. Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer. J Pain Symptom Manage. 2016 Dec;52(6):822-831. doi: 10.1016/j.jpainsymman.2016.07.005. Epub 2016 Aug 10. PubMed PMID: 27521528.
- Rice DC, Cata JP, Mena GE, Rodriguez-Restrepo A, Correa AM, Mehran RJ. Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to Thoracic Epidural Analgesia. Ann Thorac Surg. 2015 Jun;99(6):1953-60. doi: 10.1016/j.athoracsur.2015.02.074. Epub 2015 Apr 23. PubMed PMID: 25912739.
Endoscopic Mucosal Resection Program
The department’s Endoscopic Mucosal Resection Program treats early stage esophageal cancer. Such techniques avoid the need for removing the esophagus and replacing it. This means patients can continue to swallow and eat normally. This multidisciplinary program has been very successful at proving organ-sparing techniques are appropriate for early stage disease and result in a high cure rate.
Faculty Spotlight
Reza Mehran, M.D.
Professor, Thoracic and Cardiovascular Surgery
There is no project that is too small or too complex, to make a life a good cancer free life.
Thoracic Surgery and Cardiovascular Surgery at our Houston Area Locations
We provide cancer care at several locations in the Houston area, including West Houston, Sugar Land, League City and The Woodlands.
Our thoracic and cardiovascular surgeons provide care to patients at these locations. Their services partner with our main campus in the Texas Medical Center, so patients can receive the same expert care where it is most convenient for them.
The Woodlands
West Houston
Sugar Land
League City
For appointments, call the Thoracic Center at 713-792-6110