Introduction

Thoracic surgery has existed as a specific surgical discipline for more than a century. Initially, its main focus was surgery for tuberculosis and bronchiectasis. However, since 1940, rapid progress has been made in surgery for lung cancer, of the oesophagus and, most spectacularly, of the heart. After 1960, cardiac surgery became a separate subspecialty with an emphasis on coronary bypass surgery, valve surgery and congenital heart surgery. In most European countries, general thoracic (noncardiac) surgery is now well demarcated  and exists as a separate specialty. However, the number of centres performing thoracic surgical interventions in Europe is unknown and a substantial number of thoracic surgical procedures are still performed outside dedicated thoracic surgical  units. Consequently, no accurate figures on the total number of operations are currently available. As an example, thoracic surgery is not a specifically defined entity in Belgium, where it falls within  the discipline of general surgery, together with abdominal, cardiac, vascular, paediatric and trauma surgery. Approximately 2000 pulmonary resections are performed each year in Belgium but only a minority of centres carry out more than 50 major thoracic operations per year. The other operations are spread widely over smaller centres performing less than 10 interventions yearly.

In some other countries (for instance the UK), thoracic surgery is part of the framework of cardiothoracic surgery. In Germany, large free-standing units exist in combination with respiratory medicine, together with smaller cardiothoracic units and nonspecialised thoracic surgery units within general surgical clinics. Clearly, therefore, there is still no uniformity regarding general thoracic surgery in Europe. To define a more precise structure for general thoracic surgery, a working group has been established by the European Association for Cardio-thoracic Surgery (EACTS) and the European Society of Thoracic Surgeons (ESTS).

Recently, the Union Européenne des Médecins Spécialistes (UEMS) has created a specific thoracic surgical division, related to its general and cardiothoracic surgical sections. The division’s statutes were finalised in June 2012 and representatives from each European country will be nominated. Specific criteria for training and accreditation in thoracic surgery are being developed.

The UEMS division of thoracic surgery is currently surveying the practice of thoracic surgery throughout the European Union (EU). At the time of writing, responses have been received from 22 EU member states: in 11, thoracic surgery is a separate single specialty; in eight, it is considered part of cardiothoracic surgery; and in three, there is no separate specialty of thoracic surgery.

To obtain more precise data on the number of general thoracic surgical procedures carried out in Europe, several large databases have been created. The ESTS has established a voluntary database for general thoracic surgery. In 2011, a total of 24 574 lung resections were reported: lobectomy (removal of a lung lobe) represented 57.5% of cases and pneumonectomy (removal of a lung) 9.5%. A total of 16 710 cases of primary lung cancer were reported, lobectomy and bilobectomy being performed in 76% of cases. Most submitted cases originate from France, where a national database is already established with contributions from 90 thoracic surgical units. The Second National Thoracic Surgery Database Report of the Society for Cardiothoracic Surgery in Great Britain & Ireland, published in 2011, records an impressive total of 109 388 primary lung cancer resections, performed between 1980 and 2010 – with a significant increase in the rate from 2005 onwards.

See the entire Thoracic-surgery Chapter