A tradition of excellence
Thoracic surgery has held a prominent role at McGill University for generations, from the pioneering work of Edward Archibald, the world-wide reach of Norman Bethune, to the innovative clinical care of Dag Munro whose work led to the world’s first lung transplantation. Continuing this remarkable line of surgeons, David Mulder has led the MUHC Thoracic Division from its inception as a division separate from Cardiac Surgery in 2004 until 2013, at which point Dr. Lorenzo Ferri was given the near impossible task of filling Dr. Mulder’s shoes.
Centralization of complex surgical oncology procedures
Over the past decade there has been a strong push to centralize complex surgical oncology procedures around the world, including in Quebec. Indeed, recognizing the complexity and multidisciplinary care of thoracic oncology patients, the Quebec Ministry of Health has developed a plan to further centralize Thoracic Surgery across the province to ensure high quality and efficient care for all patients.
The literature is abound with data in support of centralization of pulmonary resection (all or partial removal of the lung) and particularly so for esophagectomy (all or partial removal of the esophagus). High-volume centres with a much more multi and inter-disciplinary approach consistently demonstrate fewer complications, less mortality, and improved oncology outcomes.
The Division of Thoracic Surgery and the Department of Surgery at McGill have embraced this ideal. Accordingly, we have completely centralized thoracic surgical care first within the MUHC, then McGill University, and finally, across the entire region (RUIS McGill).
Reorganization of thoracic surgery services at the MUHC
With the retirement of Dr. Jean E. Morin from clinical practice in 1995, the long presence of Thoracic Surgery at the Royal Victoria Hospital (RVH) officially came to a close as all MUHC activity within this surgical domain was transferred to the Montreal General Hospital (MGH).
With the transfer of Cardiac Surgery to the RVH in 2008, the opportunity to develop a dedicated thoracic surgical nursing unit was grasped. Indeed, this has led to a unit comprised of nurses, physiotherapists, and nutritionists that help provide comprehensive care to thoracic oncology patients through all stages of disease.
More recently, after strategic planning within the McGill hospital network, a University wide Division of Thoracic Surgery was established in 2011 encompassing both the MUHC and the Jewish General Hospital (JGH). Surgical services are maintained at both sites. However, complex procedures (ex. all esophagectomies, complex pulmonary resections) are steered to the MGH.
A more and more active division
These initiatives have led to a greatly expanding clinical volume with pulmonary resections increasing by 70 per cent over the past 10 years, and expanding the esophageal resection volume three-fold over the same time period. The increased activity is able to support a large clinical teaching unit (CTU). Although there is not yet a dedicated thoracic residency training program, the CTU comprises between 4-6 residents per period from both Cardiac and General Surgery.