Shim Young-mog
Professor in Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine
Shim Young-mog has built his reputation as one of Korea’s best and most prolific surgeons in his fields, having treated more than 5,000 lung cancer and 1,500 esophageal cancer patients.
These so-called “silent killers,” in most cases, remain undetected in the early stages because they do not cause any obvious symptoms such as difficulty in breathing and hemoptysis until they turn fatal and doctors can no longer do anything. For this reason, until the late 1980s, few surgeons in Korea dared to try to remove tumors from the patient’s lung or esophagus with a scalpel. Surgery was considered meaningless for the cancers since it barely affected the patients’ five-year survival rates. “It was a routine to send almost all patients with lung or esophagus cancer to radiotherapists. Surgery was rarely performed at that time,” Prof. Shim Young-mog of Samsung Medical Center (SMC) said in an interview. “When I asked other doctors to send me the patients for surgery, they were skeptical.” Shim is one of the first Korean surgeons who have explored little-known fields since he started his career at the Korea Institute of Radiological and Medical Sciences (KIRMS) in 1987. In less than three decades, palpable improvements and changes in the treatment of such cancers have been made in the country. “Only 20 years ago, it was common for rich Koreans to go to other countries to get lung or esophageal cancer surgery,” he said. “But today, most people think it is a waste of time and money. In fact, many patients from abroad come here to get surgery.” The five-year survival rates for stage IA and IIIA lung cancer patients at SMC are 82 percent and 35 percent, respectively, better than the developed country averages published by the International Association for the Study of Lung Cancer (73 percent and 24 percent, respectively). The five-year overall survival rate for esophageal cancer with regard to Shim’s team is 55 percent, which is among the world’s highest. “At that time, there was no surgeon at the KIRMS capable of performing surgery for the two cancers,” Shim said. “So, I had to teach myself almost everything, learning mainly from foreign medical journals.”
Since then, he has built his reputation as one of the nation’s best and most prolific surgeons in the fields, having treated more than 5,000 lung cancer and 1,500 esophageal cancer patients at KIRMS (1987-1994) and SMC (1994-present). There are no secrets to his impressive achievements. When asked, he said, “Plenty of surgery experience at Seoul National University Hospital and Armed Forces Capital Hospital probably helped.” Also, perhaps above all, he is just a natural-born doctor who has strong will power and tenacity. “Because I gave my word to other doctors at the KIRMS that I can treat patients better with surgery, I did not want to disappoint them and myself,” he said. “I worked really hard, which was difficult but also interesting. More importantly, I was lucky to have decent colleagues. We made a great team.” Indeed, he has not disappointed anyone. When he delivered a presentation at the Korean Society for Thoracic and Cardiovascular Surgery in 1992 about his work, everyone was surprised to learn that he had performed 300 esophageal cancer operations and achieved amazing low operative mortality rate of less than 5 percent. More improvements in the fields have been made since. Yet, Shim believes his work is far from over. “Lung and esophageal cancers are still among the most fatal ones,” he said. “My work won’t be done until they are conquered.” Early detection is the key to improving survival rates for cancer patients, he said. “Many cancers, including those of the breast and stomach, have become manageable, thanks to a combination of early detection through mammography and better treatments,” he said. “Lung and esophageal cancers must also follow the same path.” In an effort to improve diagnostic technologies, SMC adopted low-dose lung CT systems in 1999 for the first time in Korea. Because the systems can show early-stage lung cancers that may be too small to be detected by traditional X-ray, Shim believes surgeons can treat more patients at more curable stages. “However, because a low-dose CT scan releases more radiation, for now, it is difficult to tell whether regular screening is actually better for people’s health in the long term,” he said. “We need more improvements in research and development for the fields. That’s the next step we are taking.”
Robotic surgery
Every year, about 40 patients with esophageal cancer at SMC undergo robotic surgery.
In 2012, Shim adopted the relatively new technology, which causes far less pain in patients and is far more precise than conventional surgery. “If something can help patients, I’m open to it,” he said. “Such attitude is important for anyone who wants to improve.” “When I said I would adopt robotic surgery for my team, some people discouraged me, saying I ‘did enough.’ But I said, ‘No.’ If I did indeed enough for the development of my fields as they said, there is no reason for me to stay. The same principle goes to anyone who takes his or her job seriously.” In robotic surgery, the surgeon controls tiny, computer-aided robotic instruments to remove the tumors of the esophagus, while watching the surgical site on a magnified, 3D monitor of a laparoscope.
Robotic surgery’s biggest advantage is that it makes only a few one-centimeter incisions on the upper body, compared with conventional surgery, which requires more and far bigger incisions. Because of this advantage, the patient recovers faster. “It causes much less tissue damage and therefore pain to the patient,” he said. “It is mainly performed on those who are in the early stages of the cancer.” Shim said new technologies like robotic surgery will be more proactively used at SMC. In addition, the hospital will make greater investments to developing its own technologies. SMC is working to develop proton beam therapy, a relatively new form of radiotherapy for cancer. The method uses special particles called protons to destroy cancer cells and is expected to help patients with currently incurable cancers such as ocular, brain and spinal cancers more effectively.
Coping with patient death
Despite the best possible surgery and technologies, some patients die. As a surgeon specialized in treating some of the deadliest cancers, Shim has to live with the inevitable fact. “Some patients die during and immediately after surgery for unknown reasons,” he said. “While successful operations are usually easily forgotten, unsuccessful ones are not.” The families of the deceased patients sometimes put the blame on doctors, so, dealing with lawsuits is part of the profession, he said. “Feelings of guilt, sadness and powerlessness are hard things to cope with,” he said. “But they also remind me of the power that I can use for my patients. That is certainly why I am still doing this work.”