Lung transplantation is increasingly an option for patients with end-stage lung disease

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.