Swallow Your Pride

Admittedly, the esophagus is a thoracic organ after all, even if it is often ignored by many. Admittedly, it is difficult to reach from the outside. Admittedly, patients with malignant esophageal disease commonly form a high-risk group. Are these the reasons why many thoracic surgeons, at least in Germany, tend to turn away from the gullet?

When your Editor came to Hannover Medical School in 1986, esophageal surgery still was performed by thoracic surgeons in the department of Hans Borst. The postoperative care was done on our own ICU, and only if things went seriously wrong, as they sometimes did with these very sick patients, long-term ventilation and nutrition were taken over by the anesthesiologists. When the Editor left Hannover in 1995, esophageal surgery had long been taken over by the department of abdominal surgery under Rudolf Pichlmayr. This shift occurred at many places throughout Germany for various reasons, the two major ones probably being the scarcity of ICU beds with the constant increase of cardiac patients, and the very specialized development of surrogate techniques derived from those in abdominal surgery. Then, there were training issues. Profound knowledge of gastrointestinal anatomy and the respective surgical techniques were suddenly no longer required from the aspiring cardiothoracic surgeon. This was, and still is, a bit disappointing for the old school which quite often had started in general surgery both with operating and with publishing.[1]

The poor esophagus only returned to the Editor's scene when he took over The Thoracic and Cardiovascular Surgeon. It has been mentioned before that the inaugural English publication in this journal in 1963 dealt with “Reflux oesophagitis, carcinoma of the oesophagus and replacement of the oesophagus”[2] [3]–please note the beautiful British English spelling. It must be acknowledged that esophageal surgery still is the subject of a considerable part of submitted manuscripts, and in this issue we were able to compile several of them. Personally, I do not think that a present-day cardiothoracic surgeon has to particularly swallow his/her pride to pay some more attention to the gullet. It's directly behind the mitral valve, you know.

• References

• 1 Heinemann M, Probst M, Ungeheuer E. Der fibrovaskuläre Ösophaguspolyp. Med Klin 1986; 81: 299-300
• 2 Heinemann MK. 1962. Thorac Cardiovasc Surg 2012; 60: 179-180
• 3 Gunning AJ. Reflux oesophagitis, carcinoma of the oesophagus and replacement of the oesophagus. Thoraxchir Vask Chir 1963; 11: 40-44