As a division, Thoracic Surgery has a very active research program. We lead clinical trials based at SJHH, participate in national and international trials and develop surgical quality improvement initiatives. Our research is highly collaborative, with relationships with other Thoracic Surgery programs in Canada, faculties within McMaster University, the Juravinski Cancer Centre and with the Respirology, Radiology, Hematology/Thromboembolism and Clinical Epidemiology and Biostatistics programs. We have successfully received a number of grants from the Heart and Stroke Foundation of Canada, Hamilton Academic Health Sciences Organization, and the Ontario Thoracic Society among others to carry out our research activities.

We currently accept Faculty of Health Sciences and Faculty of Science 3^rd and 4^th year undergraduate thesis students.

Below is a listing of major research topics we are currently working on. For more information about a particular study, please contact the listed Principal Investigator or Laura Schneider, Research Assistant for the Division of Thoracic Surgery at 905-522-1155 x35877 or by email lschnei@mcmaster.ca

Clinical Trials

Detecting Deep Venous Thrombosis and Pulmonary Embolus in patients undergoing lung resection: A pilot study to evaluate the incidence of DVT and PE after malignant lung resections.
Dr. Yaron Shargall, Principal Investigator

After thoracic surgery, there is a risk of developing a Pulmonary Embolus (blood clot in the lung) or Deep Venous Thrombosis (blood clot in the major blood vessels in the leg) after surgery. This risk is lessened by giving patients blood thinners after surgery, but only until discharge home. We hypothesize that we can better prevent clots if this preventative blood thinner is taken for a longer period of time. In order for us to study this, we need to know the current rate of these blood clots, since the literature reports varied results for the thoracic surgery population. Using the knowledge gained from this current work, we plan to launch a second stage of the trial comparing the current standard of care to an extended preventative regimen to test if we can reduce the number of deadly clots after surgery.

Effect of the use of a digital pleural drainage system on reducing pleural effusion formation following lung resection.
Dr. Yaron Shargall, Principal Investigator

Patients undergoing lung resection have chest tubes placed in the pleural cavity to evacuate air and pleural fluid. In Canada, there are two styles of drainage systems approved for use, one involving a constant suction and the other a digital system that activates the suction only as needed. This study is a randomized, controlled trial where patients will be randomized to have either a digital drainage system (intervention group) or non-digital drainage system (the control group) after major lung resection for lung cancer. The groups will be compared for complications, the duration and functionality of the systems and the amount of inflammation identified though respirology laboratory testing. Further investigations using these pleural fluid and blood samples will seek to identify the inflammatory process after lung surgery as little is known to date.

The effect of the perioperative Non-Steroidal Anti-Inflammatory Drug (NSAID) Naproxen on pleural effusion formation after major lung resection
Dr. Yaron Shargall, Principal Investigator

After a lung resection surgery, excess fluid is formed in the pleural cavity partly due to inflammation caused by surgical trauma. While there is little published thoracic surgery specific research in this area, cardiac surgery suggests that a Non-Steroidal Anti-Inflammatory Drug (NSAID) such as Naproxen could reduce the amount of inflammation formed. This study is a randomized controlled trial comparing the current management of pleural effusion (fluid) with a placebo, or non-active treatment, and the experimental treatment using Naproxen. Should this project show that NSAID use after lung resection surgery helps limit pleural effusion while maintaining patient safety, this study has the potential for practice change in thoracic surgery leading to a possibility of shorter duration of chest tubes and shorter hospital length of stay.

Collaborative Clinical Trials

• A phase II randomized study of neoadjuvant brachytherapy followed by chemotherapy with cisplatin and 5FU compared to neoadjuvant chemoradiation with external beam radiation concurrent with cisplatin and 5FU for patients with adenocarcinoma of the esophagus

• Collaboration with Juravinski Cancer Centre: Dr. Rosalyn Juergens [Medical Oncology, JCC]; Dr. Ranjan Sur [Radiation Oncology, JCC]; Dr. Yaron Shargall [Thoracic Surgery, SJHH] Co-Principal Investigators

• Trial of two combinations of radiation and chemotherapy in resectable cancer of the esophagus and stomach:
  • Collaboration with Juravinski Cancer Centre: Dr. Rosalyn Juergens and Dr. Rachel Vandermeer, Co-Principal Investigators
• AMPLCaRe: Adjuvant melatonin in the prevention of recurrence and mortality following lung cancer resection: a randomized placebo controlled trial

• Collaboration with Ottawa University: Dr. Andrew Seely Study Principal Investigator; Dr. Yaron Shargall, Local Principal Investigator

• BRC5: Phase III Randomized Trial of Lobectomy Versus Sublobar Resection for Small (2cm or less) Peripheral Non-Small Cell Cancer
  • International collaboration with NCIC-Clinical Trials Group: Dr. Yaron Shargall, Local Principal Investigator

Health Services Quality Improvement

Thoracic Surgery Quality Improvement Database
Dr. Christian Finley Principal Investigator

Providing patients with the highest quality of care is the central priority for the thoracic surgery team at St. Joseph's Healthcare Hamilton. However, thoracic surgery is complex and successful outcomes are related to surgical training, the number of surgeries performed and factors relating to the patient themselves. There can be any number of post-surgical complications that have various effects on the patient’s final outcome and quality of life. Studies have established that a clinical database offers standardized, accurate details and time efficient data.  As such, databases are valuable investigational tools that have the capability of identifying new ways of improving clinical outcomes. We include all consenting patients’ information into the database so we can study trends and identify areas of improvement.

Development and Evaluation of a patient-focused, nurse navigated esophageal cancer program (EDAP)

Esophageal cancer is a highly lethal cancer, largely due to delayed detection and thus delayed treatment initiation. The current process for detecting, diagnosing and sending patients for treatment is highly disorganized. The development of a centralized Esophagus Diagnostic Assessment Program (EDAP) would be a primary solution to achieving rapid access to a standardized algorithm for esophagus cancer diagnosis and treatment. Together with St. Joseph’s Healthcare Hamilton, our aim is to develop a regional EDAP that oversees esophagus cancer diagnosis through a streamlined referral process and a standardized diagnosis and treatment process. The proposed DAP would provide rapid access, and improved access to high quality multi-disciplinary care, coordinated by a dedicated nurse navigator. The objectives of this project are to: Provide a consistent contact person (nurse navigator) for patients with suspected esophagus cancer for the entire cancer journey, to reduce delays on access by improving the referral process from the primary care and specialist physician, to ensure prompt scheduling of initial visit, to reduce delays for assessment, duplications and diagnostic testing, to coordinate the numerous hospital, specialist, clinic and CCAC visits, to increase multi-disciplinary esophageal cancer collaboration between care providers in the Hamilton area to ensure ongoing communication with referring physicians, to improve patient experience and satisfaction, to improve or maintain care provider satisfaction, to increase community awareness and utilization of the DAP to ensure early detection and intervention, to grow research opportunities as outcome data is available and access is improved and to provide patient and family education. We are centrally involved with evaluating the success of the program. For additional information, please see the EDAP website.

Synoptic Operative Reporting
Dr. Christian Finley Principal Investigator

After a thoracic surgery, surgeons will dictate what occurred during a procedure to a telephone service to be transcribed into a written narrative report.  The quality of this report can vary greatly, depending on the skill of the surgeon or institutional standards. Our team has led the development a synoptic operative report for lung cancer surgeries where a surgeon will complete a standardized form at the end of a procedure. This standardization increases the quality of the report, since important details used by other health care professionals are not omitted. Our team is currently working to validate the new report.

Education

Fast Track Patient Education for Lung Cancer Surgery
Dr. Christian Finley Principal Investigator

In Ontario, thoracic surgery is being condensed into larger centres with the hope of increasing the quality of care for patients and the efficient use of resources within the Canadian health care system.   This is achieved through a formal multi-disciplinary collaboration to shorten hospital stays. A drawback to the Fast Track process is that patients often describe a lower satisfaction level with their care. Our team has developed a patient education book for lung cancer surgery and a graphic pathway to visually explain the expected in-hospital progress. Please view the patient education section for the education materials to date.

Multimedia Surgical Textbook Resident Education
Dr. Christian Finley Principal Investigator

Typically, thoracic surgery residents learn from studying textbooks, still images and by observing and assisting with surgeries. Book learning is particularly limiting as it does not capture everything that can be captured in real time with the human eye, making it challenging to fully understand the procedure. To bridge the gap between images in books and the operating room, we see a need for well developed video textbooks, where experienced surgeons can record surgical techniques in a multimedia-based educational resource that will improve resident learning in the area of thoracic surgery

Creating a National Standardized Curriculum for Resident Education
Dr. Colin Schieman, Principal Investigator

In Canada, thoracic surgery learners are taught and expected to demonstrate specified non-technical  skills such as an ability to collaborate, communicate, advocate and successfully manage a professional practice. These skills are required by the Royal College of Physicians and Surgeons of Canada. At the present time, all centres are required to develop their own curriculums for each program, resulting in great variability between centres. Our team is leading efforts to standardize the curriculum across Canada through collaborative work.

Epidemiology

We are presently working with Canadian and Ontario level data to observe trends in Thoracic Surgery over the past 10 years and to determine whether there are specific risk factors that elevate the risk of poor outcomes after lung cancer surgery. To date, we have studied several questions that have resulted in a number of publications and presentations.