Black women surgeons break barriers and save lives

Two of Stanford Medicine’s boldest and brightest female cardiothoracic surgeons came together recently to make history by completing a highly complex combined heart-lung tumor resection. Leah Backhus, MD, MPH, FACS, and Elan Burton, MD, MHA, have been leading innovation at the Palo Alto VA Health Care System and changing lives for veterans with heart issues.

Dr. Backhus, Professor with the Department of Cardiothoracic Surgery at Stanford University School of Medicine, is the Chief of Thoracic Surgery at the Palo Alto VA and leads the Thoracic Surgery Clinical Research Program with grant funding through the Veterans Affairs Administration and the National Institutes of Health. Dr. Burton, MD, MHA, Clinical Associate Professor with the department, serves as Section Chief for Stanford Health Care’s Cardiothoracic Surgery's Hospital Affiliates. Through impeccable skill, attention to detail, and innovative spirit, the two women have brought new thoracic surgical techniques to Stanford Health Care patients.

Setting milestones with robotic surgery

In recent years, they have been setting milestones at the Palo Alto VA in robotic surgery. In 2018, Dr. Backhus performed the first robotic thoracic surgery and the first anatomic lung resection for early-stage lung cancer involving a right lower lobectomy. Similarly, Dr. Burton completed the first minimally invasive direct coronary artery bypass (MIDCAB), which enables surgical access to the heart with a smaller incision versus traditional sternotomy. These successes led to the two women partnering to tackle one of the toughest thoracic surgeries ever offered—a difficult combined heart-lung tumor resection.

Bringing their skills and innovation full circle in a difficult surgery

In August 2023, they came together to perform a combined lung and superior vena cava (SVC)/innominate vein tumor resection. It is an intricate and challenging surgery that requires tremendous planning, forethought, and collaboration.

“Superior vena cava reconstruction was performed in the setting of a complex resection of a tumor invading the right upper lobe and SVC, including the confluence of the innominate veins,” explained Dr. Burton. “Tumors in this area can cause significant blockages and disrupt cardiovascular blood flow, leading to serious health issues.”

The elderly patient had been diagnosed with a locally aggressive lung cancer affecting the right upper lobe of his lung, with tumor invasion into the mediastinum. Dr. Backhus was particularly concerned about the involvement of the innominate veins and superior vena cava. Prior to the surgery, the patient had undergone induction chemotherapy combined with immunotherapy.

“His response to the systemic therapy was excellent, allowing us to move forward with surgical resection, but given the prior superior vena cava involvement, this meant it was going to be an exceptionally complex procedure,” Dr. Backhus said.

The surgery demanded a different strategy than usual, so the two women had to put their skills and creativity to the test. To remove the tumor, major veins needed to be transected first, which required veno-venous bypass. Doing so maintained adequate venous drainage from the upper body and head during the resection. Drs. Burton and Backhus determined this approach would best help them achieve clear margins.

Dr. Burton considered how to maintain adequate drainage for the head and upper extremities while keeping cannulas out of areas slated for resection. Due to the involvement of the confluence of the innominate veins, Dr. Burton elected to cannulate the right axillary vein and left innominate vein for drainage with return flow through a cannula in the right atrial appendage. Dr. Burton used an aortic homograft to reconstruct the patient’s superior vena cava and bilateral innominate veins to minimize the risk of thrombosis.

The surgery was a success. The patient had an uneventful, smooth recovery and was discharged after a week. His follow-up testing revealed an exceptional pathological response with a positive prognosis. The entire Stanford Palo Alto VA surgical team was inspired by the collaboration and careful planning of the surgery.

Stanford Medicine leads the trend of women in cardiothoracic surgery

This historic case exemplifies the dedication Stanford Medicine has to promoting women and minorities in cardiothoracic surgery. According to the American Board of Thoracic Surgery (ABTS), just 4.3% of cardiothoracic surgeons in the United States are women. At Stanford Health Care, 27% of our faculty surgeons are women—six times the national average.

“Stanford Medicine is so fortunate to have extraordinary women like Dr. Backhus and Dr. Burton, that are dedicated to excellence. We are privileged to learn from their experiences and wisdom,” said Joseph Woo, MD, FACS, FACC, FAHA, Chair of the Department of Cardiothoracic Surgery at Stanford University School of Medicine.

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