Leading the Way in Lung Cancer Surgery: With an innovative style, Dr. Robert McKenna Jr. fits right in at the Institute

June 25, 2016
McKenna_008
Dr. Robert McKenna Jr. devised a minimally invasive lung surgery.

The John Wayne Cancer Institute expanded its expertise in the treatment of lung cancer when internationally acclaimed thoracic surgeon Robert McKenna Jr., MD, moved his practice to Saint John’s Health Center in November 2015. Dr. McKenna, professor and chair of thoracic surgery, is an expert in the surgical treatment of lung cancer and emphysema. He spent the previous 19 years with Cedars-Sinai Medical Center.

“The Institute is bringing in new experts and more surgeons, and the researchers here are really outstanding,” he says. “It’s very exciting.”

Originally from New York, but raised in Southern California, Dr. McKenna comes from a family devoted to medicine. His father, the late Robert McKenna Sr., was a surgical oncologist and former president of the prestigious American Cancer Society. His mother was a neonatal intensive care nurse.

And his wife, Kathy McKenna, is a former intensive care unit nurse who has worked alongside Dr. McKenna as his office manager for 20 years. They have three children together, all working in the medical field.

“There is now a huge amount of data that shows VATS is better for patients and some evidence that survival rates are better as well.”

The defining feature of Dr. McKenna’s career has been the development and implementation of a cutting-edge surgical technique called video-assisted thoracic surgery (VATS) for patients with lung cancer and emphysema.

“In the past, lung surgery would require an eight- to 10-inch incision to open the chest cavity,” he says, explaining that VATS only requires a small incision, through which the surgeon can place a small camera and surgical tools to remove parts of the lungs.

Some surgeons originally thought VATS was only suitable for simple surgeries, like biopsies. Few thought the technique could be used to remove entire lobes. “At the time, people thought it was not possible to perform a successful cancer operation that way,” he says.

He proved the naysayers wrong. Dr. McKenna performed the world’s first VATS lung cancer procedure in 1992 and went on to write the definitive book on the subject, Atlas of Minimally Invasive Thoracic Surgery. Today he’s performed more than 3,000 VATS lung cancer operations—more than any other thoracic surgeon in the world. The surgery reduces pain and shortens the patient’s recovery time while minimizing risks associated with more invasive surgery.

“I would not have done minimally invasive lung cancer surgery if I didn’t think it was a safe operation,” he says. “And 24 years later, there is now a huge amount of data that shows VATS is better for patients and some evidence that survival rates are better as well.”

Along with treating patients, Dr. McKenna also gives talks all over the world to medical professionals—some interested, some skeptical—about using VATS. He also teaches the procedure through education programs locally, nationally, and internationally.

“My next trip is to Germany,” he says. “That is one of the countries that has been resistant to this technique.”

Along with continuing to improve the surgical treatment options for early-stage lung cancer patients, Dr. McKenna is excited about research at the Institute under the direction of Dave S.B. Hoon, PhD. “Dr. Hoon is a real leader who has studied how to find cancer cells in the bloodstream for more than 30 years,” he says. “We are working on blood tests to look for lung cancer cells.” Earlier detection of lung cancer would be a major advancement since many tumors are not detected until the disease has spread.

Dr. McKenna points to promising targeted drug treatments, such as erlotinib (Tarceva). “Some patients have a protein called an epidermal growth factor receptor (EGFR) on the surface of the lung cancer cells,” he says. Erlotinib can block these EGFRs, preventing the cells from growing or multiplying.

Another promising area of research is genetic testing of patients’ tumors. One mutation he looks for is called ALK. For those that have it, a targeted therapy called crizotinib (Xalkori) shows promise. “I have a patient who had extensive lung cancer that had spread from head to toe,” he says. “He had the ALK mutation and used the therapy, and nine years later he has no cancer and he is doing great.”

Perhaps most promising, however, is the improvement of screening programs to help catch lung cancer in the early stages. People at high risk of the disease (ages 55 and older with 30 years of smoking) can undergo low-dose CT screening, which may discover tumors long before symptoms emerge and at a time when the lung cancer is much more curable. Saint John’s offers low-dose radiation and low-cost lung cancer screening.

“With no early warning systems, many people are diagnosed with advanced-stage disease and do not survive lung cancer,” Dr. McKenna says. “Screening with CT scans is well-documented to reduce mortality rates from lung cancer.”