Robert R. Shaw, MD: Thoracic Surgical Hero, Afghanistan Medical Pioneer, Champion for the Patient, Never a Surgical Society President
2012; Elsevier BV; Volume: 93; Issue: 6 Linguagem: Inglês
10.1016/j.athoracsur.2012.03.060
ISSN1552-6259
AutoresHarold C. Urschel, Betsey Bradley Urschel,
Tópico(s)Lung Cancer Diagnosis and Treatment
ResumoDr Robert R. Shaw arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander’s 7th Thoracic Surgical Resident from Michigan University Medical Center. Dr Shaw’s modus operandi was, “You can accomplish almost anything, if you don’t care who gets the credit.” He was a remarkable individual who cared the most about the patient and very little about getting credit for himself. From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson, who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center. Dr Shaw and his wife Ruth went to Afghanistan with Medico multiple times to teach men modern cardiac and thoracic surgery. They also served as consultants on Medico’s Ship of Hope in Africa. Dr Shaw initiated multiple new operations including: 1) resection of Pancoast’s cancer of the lung after preoperative irradiation; 2) upper lobe of the lung bronchoplasty, reattaching (and saving) the lower lobe to prevent the “disabling” pneumonectomy; and 3) resections of pulmonary mucoid impaction of the lung in asthmatics. Because of his humility and giving “the credit to others,” Dr Shaw was never President of a major medical or surgical association. Dr Robert R. Shaw arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander’s 7th Thoracic Surgical Resident from Michigan University Medical Center. Dr Shaw’s modus operandi was, “You can accomplish almost anything, if you don’t care who gets the credit.” He was a remarkable individual who cared the most about the patient and very little about getting credit for himself. From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson, who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center. Dr Shaw and his wife Ruth went to Afghanistan with Medico multiple times to teach men modern cardiac and thoracic surgery. They also served as consultants on Medico’s Ship of Hope in Africa. Dr Shaw initiated multiple new operations including: 1) resection of Pancoast’s cancer of the lung after preoperative irradiation; 2) upper lobe of the lung bronchoplasty, reattaching (and saving) the lower lobe to prevent the “disabling” pneumonectomy; and 3) resections of pulmonary mucoid impaction of the lung in asthmatics. Because of his humility and giving “the credit to others,” Dr Shaw was never President of a major medical or surgical association. Dr Robert R. Shaw (Fig 1) arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander’s 7th Thoracic Surgical Resident from Michigan University Medical Center.Dr Shaw’s modus operandi was, “You can accomplish almost anything, if you don’t care who gets the credit.” He was a remarkable individual who cared the most about the patient and very little about getting credit for himself.The main competition for Dr Shaw in Dallas was the Ear, Nose & Throat specialty. He didn’t have any money or instruments so he wired Dr Alexander for a $75 loan to purchase a bronchoscope so that he could perform endoscopy. He paid this off at the rate of $7.50 per month.From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson (Fig 2) who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center.Fig 2Donald L. Paulson, MD.View Large Image Figure ViewerDownload (PPT)Shaw and Paulson collaborated on a book entitled “The Treatment of Bronchial Neoplasms: A Tribute to Dr Alexander.” This book was published in 1959 in honor of Dr Alexander who expired in 1952 [1Shaw R.R. Paulson D.L. Kee J.L. The John Alexander Monograph Series on Various Phases of Thoracic Surgery The Treatment of Bronchial Neoplasms. Publication No. 111. Charles C Thomas, Chicago, IL1959Google Scholar].Dr Robert Shaw was an extraordinary physician who pioneered many operative firsts. None of these procedures was recognized widely in Boston during my training, which concluded in 1962. At the end of 1962 I had never seen any of them performed as surgical procedures until I came to Dallas, TX.The first was a superior pulmonary sulcus cancer resected in continuity with the chest wall after giving preoperative radiation therapy [2Shaw R.R. Paulson D.L. Kee J.L. Treatment of the superior sulcus tumor by irradiation followed by resection.Ann Surg. 1961; 154: 29-40Crossref PubMed Google Scholar]. The second was bronchoplasty for lung cancer, preserving the distal lung tissue and avoiding pneumonectomy (after preoperative radiation therapy) [3Paulson D.L. Shaw R.R. Preservation of lung tissue by means of bronchoplastic procedures.Am J Surg. 1955; 89: 347-355Abstract Full Text PDF PubMed Scopus (31) Google Scholar]. The third was resection of mucoid impaction of the lung (inspisated mucus in the bronchi mainly in asthmatic patients) [4Urschel Jr, H.C. Paulson D.L. Shaw R.R. Mucoid impactions of the bronchi.Ann Thorac Surg. 1966; 2: 1-6Abstract Full Text PDF PubMed Scopus (35) Google Scholar].In 1952, the American Association for Thoracic Surgery met in Dallas, TX. Sir Clement Price Thomas of the Brompton Hospital in London presented a case of bronchoplastic resection of a benign adenoma of the lung. In discussion of this paper, Dr Robert Shaw presented the first case of bronchoplastic lung cancer resection, preserving the distal pulmonary tissue and avoiding a “crippling” pneumonectomy. Mr Philip Allison was present, heard the discussion of Dr Shaw, and returned home to Leeds, England where he performed a similar operation of bronchoplastic resection for carcinoma of the lung. He then reported the “first” case in the literature ahead of Dr Shaw.Dr Shaw recognized that Mr Allison had published the paper, preempting Dr Shaw and Paulson, and receiving the credit for performing the first case. This did not bother Dr Shaw in the slightest, and he made no effort to complain about it. This was the type of individual that Dr Shaw was. He cared not at all who got the credit. Shaw and Paulson published an article on a series of patients with lung cancer who were treated with bronchoplastic resection with preoperative radiation therapy in 1955 [3Paulson D.L. Shaw R.R. Preservation of lung tissue by means of bronchoplastic procedures.Am J Surg. 1955; 89: 347-355Abstract Full Text PDF PubMed Scopus (31) Google Scholar].Mucoid impaction of the bronchi is “inspisated mucus” that creates a mass very similar to carcinoma on the chest roentgenogram and usually occurring in patients with asthma. Dr Shaw had published 2 previous papers on the subject and encouraged me to collect a group of his 85 patients, the largest series in the world, and present it at the Southern Thoracic Surgical Association in 1965 in Freeport, Grand Bahamas. It won the President's Best Paper Award for 1965 and was published in the Annals of Thoracic Surgery in 1966 [4Urschel Jr, H.C. Paulson D.L. Shaw R.R. Mucoid impactions of the bronchi.Ann Thorac Surg. 1966; 2: 1-6Abstract Full Text PDF PubMed Scopus (35) Google Scholar].Dr Shaw and Paulson developed the first thoracic surgical residency training program in Texas at Baylor University Medical Center in the late 1950s. This was subsequently moved to the University of Texas, Southwestern Medical School, and the residents rotated through Baylor University Medical Center, the Veteran's Affairs Hospital, the Children's Medical Center, and the Parkland Hospital, which were all in Dallas. There were 4 residents a year for a 2-year training period, making a total of 8 residents. Dr Shaw was a member of the early board of thoracic surgery (not the first) but was never chairman or for that matter, was never president of any surgical organization.After December 7, 1941, Dr Shaw enlisted in the Army and was sent as the Chief of Thoracic Surgery to Frenchey Hospital in Bristol, England. He developed this into an excellent thoracic surgical unit, treating patients evacuated from Europe and North Africa. Subsequently, he turned the unit over to Mr Ronald Belsey. Dr Shaw moved on to head the Thoracic Surgical Center at the American Hospital in Paris after D-Day. He and Ronald Belsey became great friends.The American Association for Thoracic Surgery met in Toronto in 1990, 2 years before Dr Shaw's death. I had arranged for him to travel with me to Toronto to celebrate Mr. Belsey's 80th birthday there, (it was also Dr Shaw's 80th year). Because of their friendship, Dr Shaw particularly enjoyed the meeting.For many years, the University of Toronto sent approximately 50 thoracic surgical fellows to Dallas for thoracic training with us. The trainees under Dr Pearson in thoracic surgery (such as Bob Ginsberg) were trained in cardiac surgery in Dallas, and the ones from Dr Bigalow in cardiac surgery in Toronto were trained in thoracic surgery in Dallas.During World War II, Dr Shaw served under the direction of Dr Edward Churchill, the US Chief Surgical Consultant for the European and North African theaters. Dr DeBakey was Dr Churchill's liaison between North Africa and European surgery and Fred Ranken, the Surgeon General of the United States in Washington DC. Because of their close relationship and the fact that Dr Shaw also was familiar with Dr Michael DeBakey, they collaborated on multiple problem-solving events. Whenever Dr Churchill or any physicians under him encountered problems, Dr DeBakey would relate them to Fred Ranken, and they would all make an attempt to solve these problems at the front. Dr Shaw mentioned his frustration to Drs Churchill and DeBakey because many of the surgeons were able to perform standard procedures such as gastrectomies, cholecystectomies, and so on, but were unable to handle a bullet wound that went through the aorta, lung, and liver in a situation in which they had not operated before. This was because of the rigid training program modeled after the German Halstead Geheimrat training method. Dr Shaw helped Dr Churchill and Dr DeBakey recommend marked changes in the American thoracic surgery training programs after the war. Increased responsibility became a part of Dr Shaw's residency program as well as generally across the United States. Thoracic surgical residents got much more responsibility and freedom and less rigid training. They were able to think much more for themselves. These 3 physicians also collaborated in the development of the mash unit, where patients arrived into central areas by helicopter for surgical procedures. These did not materialize in World War II; however it became the standard procedure and method of management for surgical problems in the Korean War.In 1958, Dr Shaw, a devout Christian, returned to Afghanistan to fulfill a promise that he made at the Khyber Pass when he was 18 years old. This was that he would come back and minister to the people in Afghanistan in any way that he could, not knowing at 18 that he was going to be a thoracic surgeon. (While in medical school, Dr Shaw developed tuberculosis and, as many other physicians at that time with tuberculosis, he developed an interest in thoracic surgery). He was accompanied to Afghanistan by his wife Ruth, who was a surgical nurse (Fig 3) and a very valuable asset. They had 1 son (Robert) and 2 daughters (Setta and Jean).Fig 3Ruth and Robert R. Shaw, MD.View Large Image Figure ViewerDownload (PPT)Dr Shaw established the first thoracic surgical unit in Kabul, the capital of Afghanistan, in 1958 and wrote this description of Afghanistan (Fig 4) (these are his words): “Between the Oxus River (the border between Afghanistan and Pakistan) and the famed Khyber Pass, lies the ancient Aryana (modern Afghanistan), a thoroughfare for civilizations from the Silk Road to the present. It has the same general area as Texas and the same latitude. There are multiple mountain peaks from 15 to 20 thousand feet, many fertile valleys, and in the southwest of Afghanistan is the Desert of Death.” The Silk Road in his description went from China to Europe as a trade route carrying silk 1 way and various other goods in the opposite direction.Fig 4Map of Afghanistan.View Large Image Figure ViewerDownload (PPT)The Khyber Pass, the “oldest silk road pass” between Asia and Europe was a strategic military route used by Alexander the Great, Sirus the Great, Darius the First, Genghis Khan, Timur Lane (who established the Moghul Empire in India), Babur the Tiger, and Ranjit Singh (who led the Sikhs into that part of India).Dr Shaw went to Afghanistan with a nonprofit group called Medico, which was started by Dr Tom Dooley, and involved various countries from which physicians, nurses, and other medical personnel would go voluntarily. Because of Dr Shaw's previous interest, he was sent to Afghanistan, in particular to Kabul, to set up a thoracic surgery unit and later to the Ship of Hope, which traveled around Asia and Africa (also part of Dooley's Medico) (Fig 5, Fig 6). The Ship of Hope is no longer in existence except as a financial nonprofit organization (the Ship of Hope has been extinct almost 45 years; however it still receives roughly $50 million a year designated for its nonprofit charity). Currently, however, it has been replaced by the Mercy Ships, based in Tyler, TX and on which board I serve as an advisor. It goes to Africa and Asia and is staffed by physicians, residents, nurses, and other personnel volunteers from a week to 2 months at a time. The value of being on a ship is that there is less risk of physical danger from belligerent rebels because you have the security of living and working away from land. It has its own water supply and is able to control its environment so that infection and many of the other risks of such a venture are minimized.Fig 5Ship of Hope, which was part of Medico founded by Dr Tom Dooley.View Large Image Figure ViewerDownload (PPT)Fig 6Dr Shaw working for Medico in Kabul.View Large Image Figure ViewerDownload (PPT)Under the egis of Medico, Dr Shaw developed the first thoracic surgical hospital in Afghanistan (Fig 7). It was called the Avicena Hospital, and he performed procedures such as closed mitral commissurotomy, thoracoplasty, and resection for tuberculosis, empyema decortication, hydatid cyst evacuation, and esophagectomy for cancer. He trained the local physicians and residents to perform these procedures. His wife Ruth served as a nurse with him, but frequently she would get sick with hepatitis or hydatid cyst disease, whereas Dr Shaw fortunately was not ever seriously ill during the multiple times that he went to Afghanistan. Dr Shaw trained the local physicians in thoracic surgery as well as performing multiple other operations. He later established a clinic in Kabul called IBN Sina Clinic. It was the first thoracic surgical unit in Kabul in the Avicina Hospital.Fig 7Dr Shaw … and Then Came Surgery.View Large Image Figure ViewerDownload (PPT)He trained 2 Afghan physicians, who he sent back to Dallas over a period of 1 to 2 years; these physicians later became Ministers of Health for the country of Afghanistan. This occurred before the Taliban.In 2000, 1 of the Pakistani physicians, Dr S. Amjad Hussain wrote an excellent article in the Bulletin of the American College of Surgeons called “Of Billroths and Beethovens” [5Hussain S.A. Of the Billroths and Beethovens.J Am Coll Surg. 2004; 199: 757-759Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] saying that he traveled many times from Peshawar in Pakistan, across the Khyber Pass, to Kabul in Afghanistan and worked with Dr Shaw, who trained him in closed mitral commissurotomy for mitral stenosis, a common disease in Afghanistan. Later Dr Hussain came to the United States to Toledo, OH where he worked at the Ohio State Medical School as a thoracic surgeon. He recently returned to Afghanistan to do research for the “Toledo Blade” and the “Detroit Free Press” newspapers on the Taliban [6Hussain S.A. The Taliban and Beyond: A Close Look at the Afghan Nightmare. BWD Publishing, Perrysburg, OH2001Google Scholar]. There was no evidence of Dr Shaw being there, no plaque, and nobody remembered anything about it or him. The Taliban had wiped all history totally clean. His point was that there was no way to remember history, which was critical for the future. This is why he felt “Billroths” and “Beethovens” were so important for understanding the value of history lessons for the future.I arrived in Dallas the last day of 1962 and began practice the first day of 1963 at Baylor University Medical Center and at Parkland Hospital as a member of the faculty at the University of Texas Southwestern Medical School. On November 22, 1963, Dr Shaw and I were the only 2 thoracic surgeons in Dallas. The others were attending the Southern Thoracic Surgical Association Annual Meeting in San Antonio, Texas. This is ironic in the sense that we were the only 2 thoracic surgeons in town the day that President Kennedy came here to lecture. I made rounds at Parkland at 7 am and Dr Shaw made rounds at Baylor at the same time. We then changed places, I crossed over town in Dallas to Baylor and Dr Shaw did the reverse going to Parkland. I went across Turtle Creek Boulevard and watched President Kennedy sitting up in the back of his convertible going toward the downtown area where he was to give his talk. By the time I reached Baylor, the news of the assassination was on television. As Chief of Thoracic Surgery at the Medical School, Dr Shaw successfully operated on Governor Connally, who had a thoracic gunshot wound.The type of practice that Dr Shaw and Paulson had in Dallas was relatively foreign to my training at the Massachusetts General Hospital. In addition to the new operations that they had devised, which I had never seen, their office practice was much more “aggressive” than anything that I had witnessed in Boston. The endoscopy procedures involved rigid bronchoscopy and esophagoscopy with the patient awake, as well as empyema drainage, bronchography for bronchiectasis, and so on. We performed pneumothorax and pneumoperitoneum for tuberculosis with the patient awake in the office.Dr Shaw, Paulson, and a pulmonologist of great renown named John Chapman were experts in the therapy of coccidioidomycosis and histoplasmosis. They defined an imaginary line between Dallas and Ft. Worth. If the patient were born or resided east of the line, the fungus was histoplasmosis, which was endemic in the Mississippi River drainage area. To the west of the line between Dallas and Ft. Worth, patients who were born or lived there always had coccidioidomycosis or San Joaquin Valley Fever, which was endemic in the area where the mesquite tree grew.Regarding the lung cancer surgical center, which was the largest in the United States, most patients received preoperative radiation therapy and preoperative chemotherapy when it became available. I arrived in Dallas concomitantly with the availability of cyclophosphamide. After preoperative radiation therapy, which was given for 2 weeks followed by a 2-week waiting period, I would give the cyclophosphamide the evening before pulmonary resection for the cancer. From this lung cancer surgical experience developed TOPA (Texas Oncology Physician Associates), the “largest group practice of oncologists in the world.” They currently see approximately 100,000 new patients with cancer each year in a 5-state area of Texas, Louisiana, Oklahoma, New Mexico, and Arkansas.Dr Shaw had many favorite aphorisms that he liked, such as, “Life is not a matter of holding good cards but of playing a poor hand well” by Robert Louis Stephenson or“Life is short,The art long,The occasion instant,The experiment perilous,And the decision difficult,”by Hippocrates.Regarding the management of Pancoast's syndrome, in 1953, Dr Shaw was treating a patient who had superior sulcus tumor growing into the chest wall, eroding the first rib, and invading the lower trunk of his brachial plexus. The patient was approximately 2 weeks into his radiation therapy, which was the only therapy for the disease at that time, and the results were relatively poor. There was no surgical procedure anywhere performed for that disease at that time. This patient was having so much pain that he would constantly talk to Dr Shaw and tell him we had to stop the radiation. He would come to Dr Shaw's office every day and tell him he just could not stand it anymore, he was suffering so much and he wanted Dr Shaw to operate on him. Dr Shaw said there were no good results from operations for this disease, saying, “it's inoperable,” and “I would be doing you a disservice.” Every day the patient would return and finally said, “If you don't do something Dr Shaw, I'm going to kill myself,” so Dr Shaw scheduled him for operation, took out the tumor along with 4 ribs of the chest wall and the lower trunk of the brachial plexus. He closed the chest, expecting the patient to die. The patient not only survived but also lived longer than Dr Shaw and became the model for an “unbelievable miracle.” Subsequently, management of these patients became surgical and would involve giving the patients preoperative radiation therapy of 3000 cGy, a 2-week interval to let the radiation work, block the lymphatic vessels, and injure the cells so that if any were spilled during operation they would not “take.” An en bloc resection of the lung, chest wall, and lower trunk of the brachial plexus was then performed. The results were better than anyone could ever expect. Of 511 patients evaluated, 404 patients completed treatment over 50 years. Operative mortality occurred in only 3 patients, and there was a 35% 5-year survival.In addition, Dr Shaw would occasionally use the anterior approach, which was later popularized by Dartville. If the artery was involved, he would resect the artery and interpose a graft. Occasionally the tumor would be touching the vertebrae and even invading the outer rim of the vertebrae. Because of Dr Shaw's vast experience with operations for tuberculosis of the spine, he pioneered the procedure of partially resecting several vertebrae and interposing a prosthesis, with support from a neurosurgeon. These patients also did much better than expected. Later this was expanded by Dr Garrett Walsh of M.D. Anderson Hospital. These results are all depicted in our book, The Atlas for Thoracic Surgery by Urschel and Cooper [7Urschel Jr, H.C. Cooper J.C. Atlas of Thoracic Surgery.1st ed. Churchill Livingstone, New York/London1995Google Scholar] and Pearson's Thoracic Surgery [8Pearson F.G. Urschel Jr, H.C. Thoracic Surgery. 1st ed. Churchill Livingstone, New York1995Google Scholar]. (In 1983, Dr Cooper performed the first successful lung transplant in the world.)Ironically, the May 29, 1953 was the day that Dr Shaw performed the first successful surgical procedure on the patient with superior pulmonary sulcus tumor and “preoperative irradiation.” The same day across the world, Sir Edmund Hillary “summited” Mount Everest. Mount Everest looked very similar to the pathologic specimen of the superior sulcus tumor and because of the irony of the 2 “miracles” on the same day, we put together a presentation entitled, “Pancoast Tumor: the Mount Everest of Thoracic Surgery,” which I presented at surgical grand rounds at the Brigham & Women's Hospital (Harvard Medical School) as Visiting Professor.The Kunde Hospital on Mount Everest is the highest in the world (taller than 15,000 ft) and treats many young patients with tuberculosis (Fig 8). This hospital was established by Sir Edmund Hillary for the Sherpas, with advice from Dr Shaw.Fig 8Dr Urschel with child patient at Kunde Hospital.View Large Image Figure ViewerDownload (PPT)Ironically, Dr Shaw made many great contributions. He did not care who got the credit, was 1 of the earliest members of the Board of Thoracic Surgery, but never Chairman. He was never president of any surgical society. Dr Paulson and I were on the Board of Thoracic Surgery and he became Chairman, as I did on the Residency Review Committee for Thoracic Surgery and many other organizations, but again, this mattered not at all to Dr Shaw, whose main concern was always the patient. Dr Robert R. Shaw (Fig 1) arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander’s 7th Thoracic Surgical Resident from Michigan University Medical Center. Dr Shaw’s modus operandi was, “You can accomplish almost anything, if you don’t care who gets the credit.” He was a remarkable individual who cared the most about the patient and very little about getting credit for himself. The main competition for Dr Shaw in Dallas was the Ear, Nose & Throat specialty. He didn’t have any money or instruments so he wired Dr Alexander for a $75 loan to purchase a bronchoscope so that he could perform endoscopy. He paid this off at the rate of $7.50 per month. From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson (Fig 2) who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center. Shaw and Paulson collaborated on a book entitled “The Treatment of Bronchial Neoplasms: A Tribute to Dr Alexander.” This book was published in 1959 in honor of Dr Alexander who expired in 1952 [1Shaw R.R. Paulson D.L. Kee J.L. The John Alexander Monograph Series on Various Phases of Thoracic Surgery The Treatment of Bronchial Neoplasms. Publication No. 111. Charles C Thomas, Chicago, IL1959Google Scholar]. Dr Robert Shaw was an extraordinary physician who pioneered many operative firsts. None of these procedures was recognized widely in Boston during my training, which concluded in 1962. At the end of 1962 I had never seen any of them performed as surgical procedures until I came to Dallas, TX. The first was a superior pulmonary sulcus cancer resected in continuity with the chest wall after giving preoperative radiation therapy [2Shaw R.R. Paulson D.L. Kee J.L. Treatment of the superior sulcus tumor by irradiation followed by resection.Ann Surg. 1961; 154: 29-40Crossref PubMed Google Scholar]. The second was bronchoplasty for lung cancer, preserving the distal lung tissue and avoiding pneumonectomy (after preoperative radiation therapy) [3Paulson D.L. Shaw R.R. Preservation of lung tissue by means of bronchoplastic procedures.Am J Surg. 1955; 89: 347-355Abstract Full Text PDF PubMed Scopus (31) Google Scholar]. The third was resection of mucoid impaction of the lung (inspisated mucus in the bronchi mainly in asthmatic patients) [4Urschel Jr, H.C. Paulson D.L. Shaw R.R. Mucoid impactions of the bronchi.Ann Thorac Surg. 1966; 2: 1-6Abstract Full Text PDF PubMed Scopus (35) Google Scholar]. In 1952, the American Association for Thoracic Surgery met in Dallas, TX. Sir Clement Price Thomas of the Brompton Hospital in London presented a case of bronchoplastic resection of a benign adenoma of the lung. In discussion of this paper, Dr Robert Shaw presented the first case of bronchoplastic lung cancer resection, preserving the distal pulmonary tissue and avoiding a “crippling” pneumonectomy. Mr Philip Allison was present, heard the discussion of Dr Shaw, and returned home to Leeds, England where he performed a similar operation of bronchoplastic resection for carcinoma of the lung. He then reported the “first” case in the literature ahead of Dr Shaw. Dr Shaw recognized that Mr Allison had published the paper, preempting Dr Shaw and Paulson, and receiving the credit for performing the first case. This did not bother Dr Shaw in the slightest, and he made no effort to complain about it. This was the type of i
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