Initial clinical outcomes after completion of training in a Canadian Royal College thoracic surgery program

Thoracic procedures are currently performed by general and thoracic surgeons. Initial clinical outcome after training is a good measure of the quality of the surgical training received.

We examined the morbidity and mortality for pneumonectomy, lobectomy and esophagectomy during one surgeon's first 2 years of practice; we collected data prospectively. The results were based on the experience of the only dedicated thoracic surgeon (5 years of general surgery and 3 years of thoracic surgery training with certification from the Royal College of Physicians and Surgeons of Canada) at the largest tertiary care hospital of Brown University School of Medicine.

During the 2-year period, 154 major pulmonary resections (20 pneumonectomies, 134 lobectomies) and 25 esophagectomies (18 transhiatal, 4 Ivor-Lewis, 2 thoracoabdominal, one 3-incision) were performed. Mortality for major lung resection was 1.9% (pneumonectomy 5%, lobectomy 1.5%), and morbidity was 27% (pneumonectomy 35%, lobectomy 26%). Mortality for esophagectomy was 4%, and morbidity was 36% (anastamotic leak 12%).

These results compare favourably with clinical outcomes published from several large series. Thoracic surgical training in Canada is adequate and prepares surgeons well to perform major thoracic procedures. A database of the initial results from all graduates of thoracic surgery training in Canada is needed. Such a database could be used to compare the initial results of thoracic procedures performed by general and thoracic surgery graduates from Canada and the United States.