Thoracic surgery in Estonia.

Estonia, a small Northern European country with the population of 1.3 million, has two centres of thoracic surgery, both established in 1960s. One is in the capital Tallinn, and another in the university town Tartu. Both departments cover the full spectrum of thoracic surgery, apart from oesophageal cancer surgery, yet including paediatric operations and chest trauma management. However, the focus is on lung cancer surgery. Currently, the proportion of lung cancer cases treated surgically is 20% in Estonia. Between 2000 and 2015 the proportion of lobectomies increased from 53% to 76%, while pneumonectomies decreased from 28% to 8%. Although the absolute number of lung cancer operations in Estonia is small, upon need complex and extended resections are performed. In the last decades a considerable survival gain of lung cancer patients has been observed. Minimally invasive surgery is widely used since its implementation in 1995, with the list of indications constantly evolving. In 2005, first video-assisted thoracoscopic (VATS) thymectomy and lobectomy were performed. VATS as surgical access in lung cancer operations exceeded thoracotomy in 2015 and is currently considered in all cases. In 2018, the first uniportal VATS sleeve-lobectomy was performed. The lung transplant program is functioning together with other solid organ transplant programs only at the Tartu University Hospital. Up to now, 33 lung transplantations have been performed, including lobar transplantations, a paediatric case, a few urgent cases for patients on extracorporeal membrane oxygenation (ECMO), and two re-transplantations. General thoracic surgery is a separate monospeciality in Estonia with an independent 5-year residency program, which is arranged by the Medical Faculty of University of Tartu. In last years, thoracic surgery related research in Estonia has mainly focused on lung cancer detection and management. Currently, a national lung cancer screening program feasibility study is being led by thoracic surgeons.