Savannah cardiothoracic surgeon specializes in minimally-invasive approaches to thoracic cancer surgery
Marc Bailey, M.D., FACS
Specialty: Thoracic and Cardiac Surgery
Board certifications: The American Board of Thoracic Surgery
St. Joseph’s/Candler Physician Network – Cardiothoracic Surgery
225 Candler Drive, Suite 201
Savannah, Ga. 31405
Undergraduate: Emory University
Medical School: Medical College of Virginia, Richmond, Va.
Residency: Pitt County Memorial Hospital, East Carolina University School of Medicine, Greenville, NC
Fellowship: Cardiothoracic Surgery, University of California Los Angeles
SJ/C: What is cardiothoracic surgery?
We treat diseases of the chest – heart, lung, esophagus; anything that goes from the neck down to the belly. It used to be surgeons were more generalists where they did everything, and everyone is trained in all of cardiothoracic surgery. As treatment options and technology have evolved, many surgeons have sub-specialized, allowing them to pursue specific treatments for particular diseases. My particular interests are cancer and non-cardiac diseases of the chest, such as lung cancer, esophageal cancer and benign problems in both the lung and esophagus, in addition to heart surgery.
SJ/C: How did you get into this specialty?
I was always interested in cardiology, not the surgery, but the immediate treatments that were available at the time. I liked the electrical system. I liked to look at EKGs. I liked the basic physics of it. Then I worked in a cath lab in Richmond, Virginia, when I was in medical school. If there was a big emergency or complication, the heart surgeon would come in and grab the patient and rush into surgery. I was like, ‘Yeah, I want to do this.’ I was going to do cardiology, which is totally different track. It’s a medicine residency and cardiology fellowship but after working there for a couple of years, I knew I wanted to be a surgeon. I would follow them to the OR and watch a couple of cases. It was interesting to see how everyone worked and worked together, and I liked the idea of how the surgeon is kind of like the captain in the room and he or she dictates how things went. It involves quick decisions, and I like that.
SJ/C: What are the more common procedures you do?
The most common one is lobectomy, which is where you remove one of the lobes of the lung. You have two lobes on the left and three on the right. The best cancer operation, if the patient can tolerate it and if they have cancer in one of those lobes, is not just to pluck out that little cancer, it’s to remove that lobe where the cancer sits. That’s the best chance of not seeing the cancer again. That’s our most common operation. A pneumonectomy is where you remove the whole lung. That’s become more and more rare. We don’t do as many pneumonectomies as we used to, which is good, because it means we are saving the lung for people. In addition, another big one is treating esophageal cancer, where we remove the esophagus. We do that robotically as well too. The next couple of procedures are the mediastinum cases – thymectomies, for people who have masses in their thymus gland – and other assorted masses and cysts in the mediastinum that are causing problems or need to be biopsied.
SJ/C: Why did you get into the oncology side of the specialty?
I was trained in thoracic oncology during my fellowship at UCLA and enjoyed the cases, but did not latch onto the multidisciplinary approach and the academics of oncology until I was out in private practice. I kind of just stepped in and ran with it. I loved it, and we were a busy center, and I did a lot of cases. When the robotic technology came out for thoracic around 2010 and I started doing cases, I was in practice in Missouri. We stayed really busy, doing a couple hundred cases a year with the robot. It just changed my practice. Lung cancer specifically, you know all the bad numbers – it’s the biggest killer in men and women, more so than colon, breast and prostate combined – and we have a high smoking incidence here so there’s so much room to make an impact whether it’s picking it up early with lung screening or with smoking cessation programs or with targeted therapy for chemotherapy or really precise radiation therapy with CyberKnife® and with minimally-invasive surgery. There’s a lot of impact we can have.
SJ/C: How has technology helped you as a surgeon?
Minimally-invasive approaches to the lung, heart and everything in the chest has been proven to be better for patient recovery, better for even cancer prognosis because it reduces recovery and some inflammatory markers that can cause some recovery issues to be difficult. We’ve always been looking for the best approach that’s going to do the same operation on the inside and get the patient through what they need to get through but less invasive so they recover faster, get on with their daily lives faster, or if they have something ahead of them – chemotherapy or radiation therapy – they recover quickly enough from surgery so we are not delaying the additional treatment they need. Robotic technology has really become the gold standard on some of these operations. It allows me to remove very large tumors from the lung or mediastinum without ever spreading a rib or breaking a rib.
SJ/C: It sounds like minimally-invasive robotic surgery is better for the patient.
We have tons of data to show that these patients used to go to the ICU for a couple of days, have several drains and a spinal catheter for pain and urinary bladder catheters. All that’s eliminated. We don’t go to the ICU. They don’t have epidural catheters. They are walking right away and two to three days is the average stay, which is less than half of what we used to do. There is less blood transfusion and quicker return to both regular activity and to any adjunct therapy, like if they need to start chemotherapy. It used to be they had to wait six to eight weeks before you were built up enough to start chemotherapy. These results are very encouraging.
SJ/C: When would patient need to come see you?
Typically they will see a pulmonologist or a cardiologist before they see me. They will diagnosis the blockage or disorder. If a cardiologist needs a consultation or surgery, they will consult us and we’ll get involved at that point and stay involved afterwards. The pulmonologist or oncologist, whoever in the pathway sees the patient with a worrisome mass may send the patient to me for diagnosis or treatment if the diagnosis has already been made. I want to see more patients because if I am seeing the patient, it’s an earlier stage cancer and it’s tolerable to surgery, and it gives us the best chance of curing it. If we can jump on these lung screening programs and smoking cessation programs then we will find more early stage lung cancers and prevent some cancers from ever starting.
SJ/C: What two pieces of advice do you often find yourself sharing with patients?
The big deal is smoking. It’s the most addictive drug out there. It’s never too late to stop smoking. People will say, ‘I’ve been smoking for 40 years and I’ve got cancer, why would I stop now?’ It even has benefit right before surgery if you stop. Patients feel better when they stop and do better clinically. Secondly, no one likes to hear lung cancer and no one gets excited when a lung surgeon walks in the room but the options today – it’s not lung cancer treatment from the ‘70s and ‘80s. There are so many good treatments now that have prolonged survival and better options for a cure. It’s a heavy hit to get when you hear that diagnosis but don’t be discouraged. We have great options and a good multi-disciplinary team here that is going to jump on it.