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Jefferson Surgical Solutions

Surgeons Nathaniel R. Evans III, MD, Tyler R. Grenda, MD and Olubenga T. Okusanya, MD, provide thoracic and esophageal surgical care to patients at Thomas Jefferson University Hospital in Center City, and throughout Jefferson Health. They also lead and participate in a variety of research initiatives aimed at further optimizing that care. As Dr. Evans, who leads the Division, notes, “Our research portfolio has become very diverse, running the gamut from simple to very complex questions.”

Past clinical trials have worked to enhance care to patients with esophageal and lung cancer. For example, one aimed to identify which patients with esophageal cancer need feeding tubes after surgery and which have better outcomes without them. Another explored a similar question about which lung cancer patients benefit from surveillance chest X-rays following surgery.

An active study is exploring the optimal sequence of steps in surgical procedures for lung cancer. Dr. Evans explains that surgeons must divide the arteries and veins connected to the affected lung tissue. There is a longstanding debate about the best way to do so.

“Most surgeons do whatever they are most comfortable with or the order that’s easier for that particular patient,” he says. The Jefferson team has developed a study in which they will randomize patients into two groups and then assess whether the order affects the level of circulating tumor DNA (ctDNA) after surgery.

“Theoretically, if there is more ctDNA, there’s a higher risk of a recurrence,” Dr. Evans says. “There is some preliminary data to suggest that one method is better than the other, and we are hoping to be able to affirm or disprove those findings.” The design and operation of this trial has been facilitated by Dr. Okusanya’s participation in Bristol Meyers Squibb Foundation’s Diversity in Clinical Trials Career Development Program. As one of the first cohort in the selective group of up-and-coming clinical researchers, he has gained invaluable insight into designing and running clinical trials.

Dr. Evans and his team are also collaborating on multiple studies with the Division of Pulmonary, Allergy and Critical Care in the Department of Medicine, and the Computational Medicine Center at Jefferson led by Isidore Rigoutsos, PhD. Two studies focus on better understanding micro RNA found in lung tumors. This work aims to accomplish what Dr. Evans calls the “Holy Grail” – the ability to diagnose lung cancer with a blood test.

The thoracic surgery team has also completed numerous retrospective studies to drill down on disparities in care for lung and esophageal cancers. Dr. Evans says the findings consistently show that outcomes are worse for women, minorities and people of a lower socioeconomic class.

“Our studies have shown that it’s not just outcomes that are different,” he says. “The care that people receive is different. For example, some patients are more likely to be offered radiation when surgery might be a better option. The first step to addressing these disparities is being able to document the fact that some patients are being treated differently – often to their detriment.”

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