Cardiothoracic surgeons do a good job

Editor—Partridge provides no evidence to support his claims that cardiothoracic surgeons are less likely than thoracic surgeons to stage the extent of lung cancer objectively and assess the patients' fitness; he points out that they have “competing demands from a waiting list for coronary artery surgery.”¹ He also says that relying on cardiothoracic surgeons to do lung resections may mean that some do too few to maintain competence.

Partridge states that five year survival figures are better in those who operate more often, referring to a study showing an association between improved survival and more resections done in the hospital, with numbers performed by individual surgeons not analysed.² In three quarters of the hospitals included in the study less than 22 lung cancer resections were performed a year, with the best results being obtained in units where the annual total was over 66 (only 3% of the hospitals). This is unlikely to reflect practice on this side of the Atlantic, where almost all lung cancer resections are performed in specialised thoracic or cardiothoracic units, where the mean number of resections a year is 72 (www.scts.org/file/thoracicregister1999-00.xls).

All cardiothoracic surgeons appointed in the United Kingdom undergo training in thoracic surgery and sit the same specialist examination as thoracic surgeons. All are audited in the same national database of the Society of Cardiothoracic Surgeons of Great Britain and Ireland, the marker operation for surgeon specific mortality being lobectomy for primary lung cancer. This has shown that the results of cardiothoracic surgeons are as good as those of thoracic surgeons, with a mortality of 2.5% and no difference related to the volume of operations done (T Treasure, personal communication). Thoracic surgery is well ahead of other surgical specialties in national audit and assessment of surgeon specific mortality, solely because of its association with cardiac surgery and their joint society.

We do need more surgeons to manage benign and malignant thoracic diseases, but it seems absurd to discourage the many surgeons who are already doing a good job merely because they also operate on the heart.