Interview with thoracic oncosurgeon Bogdan Borisyuk

Bogdan Borisyuk – head of the Department of Thoracic and Mediastinal Tumors, National Cancer Institute. In an interview for MedTour, he talks about the current state of thoracic oncosurgery, about radical operations for patients with low respiratory reserves in the later stages. About the methods of pleural mesothelioma treatment developed at the National Cancer Institute and the administration of an autovaccine from dendritic cells, plastic surgery on the sternum and other innovative methods available in Ukraine.

Introduce yourself.

My name is Bogdan Borisyuk. I am an oncologist surgeon, head of the Department of Thoracic and Mediastinal Tumors at the National Cancer Institute.

What is your education, internships, refresher courses?

I graduated from the Kiev National Medical University. I specialized in surgery, then in oncosurgery. I also completed specializations in Austria and Germany. My clinical experience as an oncosurgeon is 25 years.

Tell us about your experience and modern possibilities of ribs and chest plastic surgery?

We treat a fairly wide range of neoplasms of the chest cavity, ribs, clavicle, soft tissues, mediastinum, spine. We managed to implement bone replacement with titanium prostheses with propylene mesh.

The largest number of ribs that we were able to remove and successfully replace is 11. If necessary, we remove the sternum and completely replace it. We are engaged in the removal of malignant formations of the spine and prosthetics of the vertebrae together with neurosurgeons.

How can patients in your profile deal with prevention and screening tests correctly?

Prevention is about maintaining a healthy lifestyle. Healthy nutrition, exclusion of tobacco smoking and contact with harmful substances.

Screening is needed for risk groups – for people over 45 who have smoked for a long time, had harmful production factors and have been in contact with radiation.

What are the reasons for the increased incidence of lung cancer?

Since the invention of the computed tomography, the number of patients examined has increased 35 times. Therefore, it is impossible to say unequivocally whether the incidence has increased or the quality of diagnosis has improved.

Please tell us about what operations are performed on the basis of your department?

The main direction of our activity is the treatment of malignant tumors of the lungs, chest wall and mediastinum. But we are also engaged in the removal of benign tumors of these localizations. In addition, on the basis of our department, chemotherapy, targeted and immunotherapy is carried out.

We have a very good question of diagnostics, and each patient is examined in full. In doing so, we accept current examinations performed at the place of residence.

I would like to add about the survey standards. Each patient must undergo a biopsy with histological examination and immunohistochemical confirmation. It can be performed as a result of bronchoscopy, thoracoscopy under the control of a computer tomography, or mediastinoscopy.

For patients with stage I and II cancer, computed tomography of 64 sections with contrast enhancement of the chest, abdomen and pelvis is also performed.

If we suspect higher stage III, the patient should definitely have an MRI of the brain and bone scintigraphy.

If a metastatic process is diagnosed, histological verification of metastases is required. If this cannot be done, positron emission tomography should be performed.

Which malignant tumors do it make sense to operate with endoscopic surgery, and which ones need to be operated in an open way?

It depends on the location of the tumor and the patient’s clinical situation. In my opinion, it is possible to operate endoscopically in the formations of the first stage, the rest are safer to treat in an open way.

What possibilities of bronchial plasty can modern thoracic surgery offer?

We perform bronchoplasty, angioplasty and tracheal plasty. Such situations occur in patients with locally advanced cancer. They are usually denied access to other clinics.

There are patients who, by all modern standards, need to remove the lung, while they have low respiratory reserves. We do not refuse such patients, but we do not remove all of their lungs, preserving 3-4 pulmonary segments and performing bronchospastic operations. Such operations are practically unparalleled in other clinics. In recent years, we have performed 198 such resections.

We perform resections of great vessels, vessels of the lungs – these are angioplastic operations.

Some patients require tracheal surgery. The maximum volume of the removed trachea was ¾ of the total volume of the organ.

What is the approach to the treatment of pleural mesothelioma taken in your department?

The approach to the treatment of pleural mesothelioma in our department is the same as in the rest of the world. This is a surgical treatment when it comes to the nodular form of pleural mesothelioma; and chemotherapy, radiation therapy, or pleuropulmonectomy for diffuse or metastatic forms. Pleuropulmonectomy is a complex operation, but it is also performed on the basis of our department.

There is a method of treatment with the help of chemohyperthermia – exposure to the malignant process with chemotherapeutic drugs of high temperature. This technique is unique, it was patented 15 years ago on the basis of our department.

What’s new in your department in recent years, how did you improve the survival rate?

In addition to the above-mentioned improved and adapted by us bronchoplastic operations, we also use a dendritic vaccine. For this, the patient’s blood is taken, dendritic cells are isolated from this blood, artificially immunized and returned back into the patient’s bloodstream. Thus, an individual autovaccine is obtained, which helps the patient to fight the malignant process.

What options does a patient have, for example, with stage 4 lung cancer?

About 95% of patients with stage IV lung cancer receive treatment without the intervention of a surgeon. They are shown radiation, chemotherapy, targeted and immunotherapy.

We cooperate with a histological laboratory, which, in addition to performing histological and immunohistochemical studies, allows us to compile a molecular profile of the tumor, which is very important when choosing a treatment strategy in patients with stage IV.

What is the median survival rate for patients with advanced lung cancer with the right treatment?

This is a rather complex question that has many facets. Everyone knows the statistics that the 5-year survival rate in patients with stage 4 lung cancer does not exceed 15%. However, every patient must be fought for. If the patient is normally examined and treated normally, he can live for a year or two or five. We have 2 unique cases of patients who have lived with initially diagnosed stage 4 lung cancer for more than 10 years and are currently living.

Are there any big differences in what medicine can offer in Ukraine and in European countries for the treatment of lung cancer?

In our department, all methods of treatment of formations of the lung, chest wall, ribs and trachea that are used in the world are available. We fully comply with international standards and work according to appropriate clinical protocols.

Also in Ukraine, all drugs that are produced in America, the European Union and Australia are available.

To sign up for a consultation with Dr. Borisyuk, leave a request on the MedTour website. The coordinating doctor will arrange your appointment at the National Cancer Institute and will help with travel arrangements.