[Dilemmas in thoracic surgery]

Advances in ventilation physiology have brought solutions to fundamental problems of thoracic surgery and suggested ways of coping with problems of surgical technique and cilincal pathology. The domain of thoracic surgery should cover all those areas requiring specific surgical approach to endothoracic organs, with particular emphasis on special preoperative and postoperative care of such patients. This applies to thoracic trauma as well. A specialist in general surgery the thoracic surgeon needs additional training in this specific field. Departments of thoracic surgery must be organized as special units of lagre medical centres, each serving an area of no less than one million inhabitants. We are moreover convinced that pediatric cases ought to be dealt with bu a skillful thoracic surgeon regularly working with children. In the field of surgery of lung carcinoma the effects of radicality and the influence of positive mediastinal lymph nodes on surgical outcome, as well as the selection of patients for postoperative radiotherapy are currently under discussion. Operative management of pulmonary tuberculosis is becoming simpler, the disease occurs in atypical forms and secondary complications, above all aspergillosis, are on the increase. The choice of thoracotomy for various intrathoracic interventions calls for greater selectivity. Tracheal resection with primary anastomosis has been fully accepted, whereas prosthetic reconstruction is still subject to major dilemmas. Surgical stabilization of the chest following trauma, as an alternative to internal pneumatic fixation, ought to be considered more often in the future. In the management of gastroesophageal reflux surgery tends to prevail over conservative methods of treatment, wherebu the correct choice of tests for the evaluation of reflux is a matter of great significance. Numerous problems accompanying gastroesophageal resection for carcinoma still await solutions.