Thoracic surgeons as “generalists”

Thoracic surgery deals with one of the most complex areas of the human body—the chest cavity, where respiration, circulation, and central nervous system structures interact within a very confined space. It is a specialty that combines precision, anatomical sensitivity, and a deep understanding of oncological, infectious disease, and reconstructive aspects. The focus is on diseases of the lungs, the pleura, and the mediastinum, as well as injuries and tumors of the chest wall and procedures involving the diaphragm. Thoracic surgery thus operates at the interface between vital organs and highly sensitive structures—and plays a crucial role in ensuring patients’ respiratory function, quality of life, and chances of survival.

The editorial team of the Leading Medicine Guide spoke with Dr. Jan Volmerig to learn more about this fascinating specialty.

“At its core, thoracic surgery involves the treatment of diseases within the chest cavity—particularly of the lungs, the bronchi, the pleura, the mediastinum, and the chest wall. We treat benign and malignant conditions as well as inflammatory diseases. A particular focus is on lung diseases—primarily lung cancer, but also conditions such as emphysema, infections, or congenital malformations.

The range of treatments also includes diseases of the pleura, such as pleural effusions or a pneumothorax (collapsed lung). Important for patients: “Thoracic surgery focuses exclusively on the chest cavity. Heart surgeries are performed by cardiac surgeons, and procedures on the esophagus in Germany are generally performed by specialized visceral surgeons,” explains Dr. Volmerig at the beginning of our conversation. 

---

The mediastinum is a narrow space between the heart, major blood vessels, trachea, and esophagus, where thymic tumors, neurogenic tumors, cysts, or inflammatory conditions require surgical intervention. The chest wall and diaphragm also fall within the scope of thoracic surgery: tumors, injuries, instabilities, or complex reconstructions require a precise approach and often interdisciplinary collaboration.

---

Thoracic surgery is considered far more than a traditional surgical specialty because it operates at a medical crossroads where modern oncology, high-tech surgery, critical care medicine, functional respiratory physiology, and interdisciplinary decision-making are inextricably linked.

“Thoracic surgery is a highly complex specialty that, in addition to oncology, extends far beyond mere surgical techniques. This is what makes it particularly appealing. A large part of our work involves the lungs, an organ that is vital to life and functionally linked to the cardiovascular system.

Therefore, we must have a thorough understanding of physiological and pathophysiological relationships and the effects of diseases and injuries. For this reason, some refer to thoracic surgeons as the ‘internists among surgeons.’ Furthermore, the specialty covers a broad spectrum: from tumor surgery and functional procedures to the management of severe injuries.

“Surgeries on the bony chest wall—whether for acute injuries or congenital malformations—are performed according to different principles and using different instruments than, for example, those used on the lungs,” Dr. Volmerig explains. 

Thoracic surgery has taken on a key role in modern oncology because it addresses a point where diagnosis, treatment planning, and curative prospects converge directly. It is no longer merely “the surgical arm” of lung cancer therapy, but an integral part of a highly sophisticated, multimodal treatment approach that has evolved rapidly in recent years. 

Dr. Volmerig explains: “Thoracic surgery plays a central role in cancer medicine—especially in lung cancer, which is one of the most common types of cancer. Modern thoracic surgery is closely integrated with many other medical specialties—such as oncology, pulmonology, radiology, and radiation therapy.

This means that surgery today is almost never a stand-alone procedure. Instead, an individualized treatment plan is developed for each patient that combines various forms of therapy. In addition, thoracic surgery has evolved significantly—toward gentle, minimally invasive procedures. As a result, patients benefit from smaller incisions, less pain, and a faster recovery. Surgery is often the most important treatment option when a tumor is detected early.

The goal is to completely remove the tumor and thereby provide the best chance of a cure. But thoracic surgery is also important in advanced stages: it can be combined with chemotherapy, immunotherapy, or radiation therapy. For patients, it helps control the disease and improve quality of life.” 

---

Thoracic surgery is a central pillar of modern oncology: diagnostically precise, therapeutically curative, technologically advanced, and strategically closely integrated with all other oncological disciplines. It is thus far more than just a surgical specialty—it is a crucial building block of personalized cancer medicine.

---

Thoracic surgery plays a central, often immediately decisive role in acute and life-threatening situations because it involves structures that are essential for respiration and circulation and, in the event of complications, can determine stability or decompensation within minutes. In hardly any other surgical specialty are diagnosis, intervention, and life-saving measures so closely intertwined.

 

“Thoracic surgery is indispensable in emergency situations. These include, for example, severe injuries to the chest and its organs in accidents, as well as a pneumothorax that occurs suddenly and without any external cause (air between the lung and the chest wall, causing the lung to collapse partially or completely).

In such cases, rapid surgical intervention can be life-saving—for example, to stop bleeding, treat damaged structures, or re-expand the lung. For patients, this means that thoracic surgeons are responsible not only for scheduled procedures but also for acute, often critical situations. “In addition to immediate care, a secondary procedure may often be necessary hours or a few days later,” explains Dr. Volmerig. 

Thoracic surgery also plays a special role in cases of injuries or ruptures of the diaphragm, the trachea, or the large airways. Such injuries are rare but highly dramatic: they lead to severe respiratory failure, mediastinal emphysema, or massive ventilation disorders. Surgical reconstruction is often the only way to secure the airways and restore physiological function in these cases. 

---

Thoracic surgery combines surgical expertise with an intensive care mindset, making it an indispensable component of modern acute and emergency medicine.

---

Functional procedures constitute a distinct, highly specialized branch of thoracic surgery because they are not primarily aimed at tumor control or infection management, but rather at restoring or improving respiratory mechanics, ventilation, and quality of life. They intervene in finely tuned physiological processes and require a deep understanding of how the lungs, airways, chest wall, and diaphragm work together. 

“We frequently see patients who, for various reasons, are sometimes severely limited in their daily lives and for whom surgery offers the possibility of improving their quality of life.

One example is the surgical treatment of pulmonary emphysema, in which overinflated sections of the lungs are removed so that healthier areas can function more effectively again. This often results in a significant increase in daily activity levels. Paralysis of the diaphragm—the most important muscle in the respiratory system—for example, following viral infections or as a result of injuries or surgeries, leads to severe impairments in daily functioning.

Tying a shoelace while bent over can become a struggle. Tightening the muscle can have a lasting positive effect on this. Narrowing of the trachea following inflammation or surgical procedures often leads to very distressing breathing difficulties for patients, with significant shortness of breath even during the slightest exertion. In such cases, surgical removal of the narrowing can restore nearly normal breathing,” explains Dr. Volmerig, adding: 

“Excessive sweating (hyperhidrosis), especially on the hands and underarms, can severely impair self-esteem and lead to social isolation. If conservative treatment options fail to provide relief, severing certain nerves (sympathectomy) may be the solution.

The primary goal of such surgeries is not to cure a life-threatening disease. For us, a lasting improvement in quality of life is crucial.” 

---

Functional thoracic surgery is not a niche field, but rather a highly specialized spectrum aimed at sustainably improving respiration, physical endurance, and quality of life. It combines precise anatomical knowledge with a deep understanding of the dynamics of the chest—thereby highlighting how much thoracic surgery goes beyond mere resection techniques.

---

Thoracic surgery is undergoing a period of tremendous technological advancement. Hardly any other surgical specialty has integrated so many innovations in such a short time—and hardly any other benefits so directly from them, because procedures within the chest rely on precision, minimal trauma, and exact anatomical orientation. Several developments are currently shaping the field particularly clearly and are changing both surgical techniques and strategic planning. 

“Thoracic surgery has made significant progress in recent years—particularly through minimally invasive and robot-assisted surgical procedures. In so-called keyhole surgery (VATS = Video-Assisted Thoracic Surgery) and robotic procedures, operations are performed through tiny incisions with the highest precision.

For patients, this means less pain, less physical strain, and a faster recovery. In addition, modern imaging techniques and navigation systems enable increasingly precise planning and execution of procedures—especially when removing tumors. For patients, this means even more precise and, at the same time, gentler treatment,” emphasizes Dr. Volmerig. 

---

Thoracic surgery today is a technologically advanced specialty that combines robotics, minimally invasive techniques, modern oncology, digital planning, and functional innovations. These developments not only expand the range of surgical options but are also transforming the very nature of the specialty—moving away from purely resection-based surgery toward a precise, personalized, and strategically oriented discipline.

---

In thoracic surgery, interdisciplinary collaboration is not an optional extra but the core of the entire treatment concept. It stems from the fact that diseases of the chest almost always affect multiple levels simultaneously—tumor biology, respiratory mechanics, infection dynamics, circulatory stability, and functional limitations—and can therefore only be truly understood and optimally treated through the collaboration of various specialties.

Dr. Volmerig emphasizes: “Today, the treatment of thoracic surgical conditions takes place in close collaboration among various medical disciplines. In interdisciplinary tumor boards, experts from oncology, pulmonology, radiology, and radiation therapy consult together to determine the optimal therapy for each individual patient. For patients, this means individually tailored treatment at the highest medical standard. This structured collaboration is particularly crucial for lung cancer and should take place in specialized and certified centers.” 

Another important area is functional medicine. Physical therapy, rehabilitation medicine, and thoracic surgery work closely together when it comes to emphysema surgery, diaphragm reconstructions, or chest wall corrections. Surgical intervention is just one component here—what is crucial is that postoperative respiratory mechanics are specifically trained and stabilized over the long term. 

If something unclear arises in the chest—a finding, a symptom, or an incidental discovery on an X-ray or CT scan—thoracic surgery is often the next logical step for the patient. 

“Consulting a thoracic surgeon is always advisable when abnormalities in the lungs or chest have been detected or when corresponding symptoms are present. Patients are often referred following an imaging study—such as an X-ray or computed tomography scan—during which, for example, a round pulmonary lesion or other changes were detected.

A consultation with a thoracic surgeon may also be advisable in cases of unclear findings in the chest or chronic lung diseases. We work closely with the field of pulmonology to ensure that every situation and clinical presentation is diagnosed and treated as effectively as possible.

It is important for patients to understand that a consultation with a thoracic surgeon does not automatically mean that surgery is necessary. Rather, the initial focus is on a thorough assessment and a joint decision regarding the next steps within an interdisciplinary context,” states Dr. Volmerig, emphasizing: 

“Thoracic surgical procedures are generally very safe today, especially when performed at specialized and experienced centers. In recent years, both surgical techniques and perioperative care have made great strides. Minimally invasive procedures also help reduce the strain on the body and minimize complications.

At the same time, modern anesthesia and monitoring protocols ensure a very high level of safety during and after surgery. In addition to the technique itself, the experience of the treatment team is crucial. For patients, this means that—especially in specialized centers—standardized procedures and high case volumes lead to additional safety and make an important contribution to the success of treatment.”

Thoracic surgery is on the verge of a development that will transform the field even more in the coming years than it has over the past two decades. There are many indications that the field is simultaneously becoming more technologically sophisticated, strategically expanding, and functionally realigning—and is thus becoming one of the most innovative fields in modern surgery. 

“Thoracic surgery is increasingly moving toward procedures that are even less invasive and, at the same time, more precise. Minimally invasive and robotic surgical techniques will continue to gain importance and be continuously improved.

At the same time, treatment is becoming increasingly personalized: New findings from tumor research make it possible to tailor treatments specifically to the biological characteristics of a tumor and the patient’s individual situation.

For patients, this will mean increasingly optimized combinations of different therapeutic approaches in the future—with the goal of improving chances of recovery while maintaining patients’ quality of life in the long term,” explains Dr. Volmerig, and with that, we conclude our conversation. 

Thank you very much, Dr. Volmerig, for these important insights into thoracic surgery! 

---

• Director of the Department of Thoracic Surgery and Head of the Lung Cancer Center at Ev. Kliniken Essen-Mitte, Specialist in Thoracic Surgery, FEBTS (Fellow of the European Board of Thoracic Surgery)
• Specialist in minimally invasive and robot-assisted thoracic surgery
• Renowned expert in the interdisciplinary treatment of lung cancer
• Subject Matter Expert for Lung Cancer Centers of the German Cancer Society
• Surgical Focus: Tumors of the lung, pleura, and mediastinum; metastasis surgery (including laser); chest wall reconstruction; septic thoracic surgery; management of thoracic injuries
• Treatment of rare conditions such as hyperhidrosis and myasthenia gravis
• Leads an interdisciplinary team comprising specialists in thoracic surgery, oncology, radiology, and pulmonology
• Combines state-of-the-art surgical techniques with individualized, patient-centered care