Dr. Traves D. Crabtree

Bio

Traves D. Crabtree, M.D., first came to the Washington University School of Medicine in St. Louis for a fellowship in 2002 to finish his training as a cardiothoracic surgeon.

He stayed to become an innovator.

Crabtree recently was part of the surgical team at the Alvin Siteman Cancer Center that performed the first full-lung lobectomy in the St. Louis region while utilizing the new robot-like, high definition 3-D cameras that provide the greatest precision possible with the smallest incisions and quickest recovery for a major operation.

He has become one of the region's leaders in minimally-invasive lung cancer surgery, growing his expertise with all pleural diseases, including mesothelioma, a rare cancer caused by asbestos exposure.

Crabtree also has been at the forefront of the ongoing debate between the newest stereotactic body radiation therapy (SBRT) for lung cancer and the surgical resection option with high risk patients.

Crabtree was lead chair for the two-day Continuing Medical Education course at Washington in December, titled "State of the Art Management and Controversies in Early Stage Lung Cancer."

The audience included medical oncologists, radiation oncologists, pulmonologists and those caring for lung cancer patients. The course centered on understanding issues in regard to prevention, screening, diagnosis and treatment of lung cancer. The goal was to increase the knowledge, competence and skill for all health care providers.

As part of the course, Crabtree spoke extensively and led the discussion regarding the best course of treatment for various stages of lung cancer. In a debate format regarding the treatment of Stage I Lung Cancer, he presented "Surgery Should Be the Standard of Care," while a colleague took the

"SBRT Should Be Standard Care," side of the issue.

Crabtree was selected, in part, because of his recent work. In 2010, the American Association for Thoracic Surgery published his study that compared short-term outcomes between the two competing therapies.

The unmatched comparison included surgical patients who were healthier overall and had better local tumor control than patients receiving stereotactic body radiation therapy with stage 1A disease.

The study included 462 patients who underwent surgery and 76 who received SBRT. The surgical patients were younger with better pulmonary function to start. In an unmatched comparison, the five-year survival rate was 55 percent with surgery, compared to just a 32 percent survival after three years with SBRT.

Yet in a propensity analysis that matched 57 high-risk surgical patients to 57 patients undergoing SBRT, there was little difference in freedom from local tumor recurrence, disease-free survival and overall survival at three years.

In a 2011 study with the same two therapies, Crabtree compared the relative cost-effectiveness with clinical stage I lung cancer. The SBRT was estimated to have a mean expected survival of 2.94 years at a cost of $14,153. The mean expected survival with surgery was 3.39 years at a cost of $17,629 – for an incremental cost-effectiveness ratio of $7,753.

The conclusion was that SBRT was less costly than surgical intervention for high-risk patients, but the surgical option still met the cost-effectiveness standard because of a longer expected survival rate.

Crabtree lists his areas of clinical interest as video-assisted thoracic surgery (VATS), esophageal cancer, general thoracic surgery, mediastinal surgery and pleural disease surgery.

Publications

In 2011 alone he published on topics like radial artery harvesting, sternoclavicular joint infections, mitral valve repair and the use of retrograde tube gastrostomy after an esophagectomy.