What is Thoracic Surgery?

DAVID TOM COOKE, MD, FCCP, FACS
Thursday, December 08, 2011
“What is Thoracic Surgery?” is a good question. Often times the term Thoracic Surgery is used interchangeably with Cardiothoracic Surgery, Adult Cardiac Surgery, Cardiovascular Surgery, Congenital Cardiothoracic Surgery, and General Thoracic Surgery. But for the layperson, Thoracic Surgery should be synonymous with General Thoracic Surgery.

A General Thoracic Surgeon takes care of patients with surgical diseases of the chest, generally excluding the heart and great vessels. About 80% of Thoracic Surgery involves surgery for some sort of cancer. This includes such tumors as lung cancer (which kills more people in the United States than colon, prostate and breast cancer combined), esophageal cancer, tumors of the chest wall (rib cage, sternum, etc…) and tumors of the mediastinum, or the space around the heart.

But a lot of Thoracic Surgery involves curing or helping people with disease processes that are not cancer related. This includes such procedures like thymectomy for Myasthenia Gravis, sympathectomy for hyperhidrosis or “sweaty palms”, first rib resection for thoracic outlet syndrome, myotomy for Achalasia, esophagectomy and reconstruction for end stage benign esophageal disease, plication of the diaphragm for diaphragm paralysis, resection of esophageal diverticulum, removal of cysts of the chest, lung transplantation, and providing tissue or biopsies of the lung and chest tissue to diagnose problems such as interstitial lung disease.

Much of Thoracic Surgery is now done minimally invasively by using small incisions, a thin camera and high definition monitors.  This is called Video-Assisted Thorascopic Surgery or (VATS).

A Thoracic Surgeon should always be either already board certified or in the process of being board certified by the American Board of Thoracic Surgery (ABTS). In addition to ABTS certification, many thoracic surgeons are also board certified by the American Board of Surgery (ABS). There is data that demonstrates that patients who have complex thoracic surgical disease, such as lung and esophageal cancer, have better outcomes when operated on by Thoracic Surgeons as opposed to non-Thoracic Surgeons (Birkmeyer JD et al., NEJM, 2003; Schipper PH et al., Ann Thorac Surg 2009). Also, research shows that patients may not do well after esophagectomy (removal of the esophagus) because of failure of their hospital to “rescue” them from complications (Ghaferi AA et al., Ann Surg, 2009). This fact underscores the importance that some operations should be performed by Thoracic Surgeons at high volume academic medical centers.

So what is Thoracic Surgery? Now you know!

David Tom Cooke, MD, FCCP, FACS
Blog Info
A blog provided by the UC Davis Department of Thoracic Surgery that allows patients, physicians, and anyone else who is interested or curious to learn about the important and not so publicized disease processes that affect thousands of individuals each day, such as Lung Cancer, Esophageal Cancer, Emphysema/COPD and Hyperhidrosis.
Author Bio
Dr. David Tom Cooke is an Assistant Professor in the Division of Cardiothoracic Surgery at the University of California, Davis Medical Center. He is the Section Head of General Thoracic Surgery, and the Associate Program Director of the UC Davis Cardiothoracic Surgery Residencies. He completed his cardiothoracic surgery training at the University of Michigan in Ann Arbor, general surgery residency at the Massachusetts General Hospital/Harvard Medical School in Boston, and medical school at Harvard.

Dr. Cooke specializes in non-cardiac general thoracic surgery, thoracic oncology, and surgical treatment of malignant and benign esophageal disease, and minimally invasive thoracic surgery, including VATS pulmonary resection. Dr. Cooke's research interests involve clinical studies including oncologic trials, surgical outcomes/health services research, translational research, surgical education and medical social media. He currently serves on the governing board of directors of the American Lung Association of California, and the Medial Advisory Committee of the Esophageal Cancer Education Foundation. He is the co-founder of #lcsm, the bi-monthly lung cancer social media Twitter chat.
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