Q. Why did you choose to specialize in thoracic surgery?
A. My career as a cardiothoracic surgeon arose from a fascination with the human heart and evolved to include thoracic oncology. I had been a Space Shuttle engineer in southern California after college and had read about development of artificial heart technology and other medical devices in a great publication called NASA Spin-Off. This technology was in its infancy at the time, and the thought of applying my background as an engineer while being more personally involved with individuals in need was irresistible. So, I rather suddenly changed careers.
During my surgical residency, I had the opportunity to research and develop a heart assist device, which has now been employed to help thousands of heart failure patients worldwide. After fellowship training, I had a very busy heart surgery practice in a large university setting. When I later moved to Phoenix and began practicing here, there were not many surgeons specializing in thoracic oncology, and referrals for thoracic diseases, especially lung cancer, came pouring in. I had always enjoyed this part of my training, and I found that, in addition to enjoying the surgery, I liked the deeper personal connection and special interactions required to be a good cancer surgeon.
Q. What role does thoracic surgery play in oncology?
A. Thoracic surgery plays a distinct and crucial role in the treatment of thoracic oncology and lung cancer in particular. Surgical removal of a tumor from the lung in early-stage lung cancer provides a greater chance of cure than any other therapy, including chemotherapy and radiation. In fact, if the cancer is caught early enough, surgery alone may provide long-term cure without the need for these other therapies. This is also true for some other less well-publicized chest tumors.
Q. What aspects of your work with patients do you find especially rewarding?
A. There is no question that direct, personal interactions with my patients, before and after surgery, are the most rewarding part of my job at Cancer Treatment Centers of America® (CTCA). Even when a patient is not a candidate for surgery, I try to develop a bond and a deep level of trust. Of course, as a surgeon, I also love operating. I’m sorry to say that I have a common surgeon’s disease in that I get a bit antsy when I’m away from the operating room for more than a few days. Fortunately this doesn’t happen very often. But I have been surprised over the years how much I enjoy seeing and talking with patients in clinic. I think all of my surgical colleagues at CTCA® feel the same way, but, in my experience, this is not a common surgical trait elsewhere.
Q. Are there specific trends in thoracic surgery as it relates to cancer treatment that you find especially promising or exciting?
A. The continued development of robotic and other minimally invasive surgical techniques are of great relevance to my practice. When I was in my advanced thoracic training about 15 years ago, most of the operations we performed were through large incisions that were quite painful to the patients and required long recovery periods. Now, the great majority of the surgeries I perform are thoracoscopic—meaning that I am operating through very tiny incisions with the aid of a small camera inside the chest. Operations that typically required a week or more of hospitalization and months of recovery now result in hospitalizations of a few days or less and a much faster recovery to full range of activities.
Robotic surgery is an extension of minimally invasive thoracoscopic surgery but the visualization and instrument control are even more advanced. The surgeon’s view during robotic thoracic surgery is truly three dimensional, and this enhances precision. Furthermore, the robotic platform allows me to operate as if I have four hands instead of two and this provides a much greater degree of control for certain procedures.
Q. What does a “typical” day-in-the-life look like for you in your current position?
A. One of the things that always attracted me to surgery, and thoracic surgery in particular, is that there is no “typical” day. This may not suit every physician but I find the unpredictability invigorating. Part of the unpredictability comes from the nature of my specialty, which involves a fair number of urgent or emergent operations—especially on the cardiac surgery side of my practice. There are some thoracic oncology emergencies as well, but the variability of cancer in each individual patient requires me to be adaptable and prepared for a wide range of possibilities.
However, there is a somewhat predictable side to my practice that occurs with the several scheduled conferences and tumor boards I run or attend each week. But even these are unpredictable in terms of the discussions about individual patients, and every patient, as we all know, is unique. I try to learn something new every day, and this always keeps things interesting.
Q. What hobbies or interests do you pursue in your free time?
A. Like many parents, I can say that I used to have a lot more hobbies and a lot more free time. My family, with three school-age children, gladly consumes most of my time outside of professional life. I still manage to set some time aside for an occasional woodworking project, martial arts training (I like the spiritual side, which is all about peace) and some very bad guitar and harmonica playing when no one is around. I also like to experience the adrenaline rush from wakeboarding, skiing and other sports when the opportunity arises.
Andrew Goldstein, MD, FACS is a cardiothoracic surgeon and Director of Thoracic Oncology for CTCA in Goodyear, Arizona. Dr. Goldstein earned a Bachelor of Science in Mechanical Engineering from Brown University and then worked as an engineer for Rockwell International in the NASA Space Shuttle Division. Inspired to adapt his scientific background to medicine, he earned his MD from Columbia University in New York and a fellowship in Cardiothoracic Surgery at Yale. Before moving to Phoenix in 2002, Dr. Goldstein was Assistant Professor of Surgery and Attending Cardiothoracic Surgeon at The Ohio State University School of Medicine.