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Ann Thorac Surg 2003;76:S11-S13
© 2003 The Society of Thoracic Surgeons
a Cardiovascular and Thoracic Surgical Research, Education and Clinical Excellence, Baylor University Medical Center, Dallas, Texas, USA
* Address reprint requests to Dr Urschel, Baylor University Medical Center, 3600 Gaston Ave, Suite 1201, Dallas, TX, USA 75246
e-mail: drurschel{at}earthlink.net
Presented at the 50th Anniversary of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 14, 2003.
The primary purpose of the newly formed Southern Thoracic Surgical Association (STSA) in 1953 was to disseminate knowledge and information and stimulate progress of thoracic surgery in the South. The secondary objective was to promote fellowship among thoracic surgeons. These remain our major goals. The excellent scientific program combined with a strong bond of fellowship have been responsible for the marked success and growth of the Southern Thoracic Surgical Association.
The first meeting of the STSA was in 1954 in Hollywood Beach, Florida, and the program was predominantly general thoracic surgery. Of the 18 scientific presentations only two were cardiovascular. Tuberculosis, fungus disease, and pulmonary infection were a large part of the venue. Several new concepts were introduced. A landmark paper was presented by Donald L. Paulson on the preservation of peripheral lung tissue by brochoplastic procedures for carcinoma. Doctor Robert R. Shaw had pioneered this work in the late 1940s and early 1950s and this was one of the initial presentations of results [1]. They had discussed it at the American Association of Thoracic Surgeons (AATS) meeting in Dallas in 1952 where Sir Clement Price Thomas was in attendance. He returned to England, performed a successful case, and published it ahead of Shaw and Paulson who had performed the initial procedure. There had been previous brochoplastic procedures but only for benign disease.
Lung cancer remained a common topic at subsequent programs and included subjects such as early staging attempts (supraclavicular lymph node biopsy, cervicomediastinal lymph node biopsy), unusual cancers (mesothelioma, alveolar cell carcinoma, giant cell carcinoma), unusual presentations (dual primaries, scar carcinomas), and resection techniques.
Esophageal disease was "futuristic" at the first STSA meeting with papers for high esophageal resection and management of obstructive lesions of the esophagus. The military experience presented the Third Army Surgical Thoracic Traumas Service results, emphasizing further the war stimulus. There was no guest speaker at the first meeting. The first official guest speaker was scheduled for the second meeting. To stimulate cardiac presentation, Dr C. Walton Lillihei was to discuss his open procedures for congenital heart disease but because of a severe snowstorm at the Greenbriar, he was unable to attend.
General thoracic surgery subjects remained dominant: lung abscess, bronchestatsis, empyema, and even a paper suggesting that vagus nerve resection for emphysema might be valuable were presented. At the third meeting Dr Cooley became our first official guest speaker and presented 75 cases of open heart surgery in an effort to balance the program between thoracic and cardiovascular surgery. Tuberculosis therapy with thoracoplasty and plombage as well as gastroesophageal reflux management were prime subjects. Reconstructing the tracheobroncheal fistula as well as the management of closed rupture of the trachea and bronchi were discussed. Staging of lung cancer improved surgical results in the late 1950s and early 1960s [2].
Consecutive case presentation had been important in tuberculosis management and in 1958 James Pate and coworkers presented 600 consecutive cases of bronchogenic carcinoma, as well as cancer coexisting with tuberculosis. Thoracoplasty was performed for tuberculosis before, as well as after, pulmonary resection. Histoplasmosis and coccidioidomycosis therapy was introduced (both medical and surgical). Interlobar sequestration of the lung and two-stage esophageal resection continued to be important subjects.
During the first 10 years there was no official publication for scientific papers presented at the STSA. In 1964 The Society of Thoracic Surgeons (STS) was formed and although The Annals of Thoracic Surgery became the official journal for the STSA as well as the STS, it initially only published a few sporadic STSA papers.
Early trauma presentations were commonly about diaphragmatic rupture but subsequent talks included esophageal trauma [3], management of flail chest [4], and tracheobronchial injury [5]. Chylothorax continued to provoke discussion of diagnosis and treatment.
What we consider today as some common devices in pulmonary surgery were introduced or discussed at early STSA meetings. The Carlen's double-lumen catheter [6] and the Robert-Shaw endobronchial tube [7, 8] opened up new approaches for pulmonary resection including the median sternotomy approach. The usefulness of the flexible esophagoscope was discussed in 1970. Fiberoptic bronchoscopy was presented as an improved approach to the diagnosis of endobronchial disease [9] at the 1973 meeting. Transbronchial needle biopsy, transthoracic fine-needle biopsy with computed tomography control, and a fiber-optic scoping of both the tracheal-bronchial tree and esophagus all improved diagnosis and management. Thoracoscopy as a diagnostic aid was emphasized at three meetings and predated the resurgence of popularity of this procedure that would come in the video-assisted era [10–12].
Arguments persisted regarding the Shatski ring and whether or not it was only a radiologic defect as Dr Shatski originally described or whether it represented an obstructive stricture secondary to gastroesophageal reflux as Wilkins and Bartlett contended.
Early esophageal topics included approaches for treatment of achalasia and management of esophageal atresia. Panel discussions, an irregular component of some of the early meetings, were held on management of obstructive lesions of the esophagus (led by Dr Osler Abbott in 1954) and on lower esophageal nonmalignant lesions (led by Dr Brian Blades in 1961). Esophageal perforation was a fairly common subject beginning in 1963 with a presentation by Foster and colleagues [13] emphasizing what we know today: need for high index of suspicion, early radiographic study, and prompt surgical intervention with suture of the perforation and proper drainage. In addition the high mortality was markedly reduced by diversion and exclusion techniques [14]. An important contribution to esophageal perforation management was presented in 1978 by Dr Cameron [15]. He discussed selective nonoperative management of contained esophageal perforations. Esophageal cancer was a frequent subject in the 1960s and 1970s. Subjects included aggressive management, replacement options, and palliation with endoluminal tubes. One paper's title summarized a belief that is still very true: "Carcinoma of the Esophagus: A Disaster." (The presentation was never published.)
After esophageal resection, interposition with a variety of conduits was discussed and included stomach, jejunum, and colon throughout the late 1950s and early 1960s. Nonsuture anastomoses of a "free segment" of jejunum between its artery and vein to the thyroid artery and vein was successful by Nakayama and with suture techniques by Hiebert.
Caustic burns of the esophagus were treated by stents [16] and sclerosing mediastinitis was discussed with new diagnostic and therapeutic options [17]. New techniques of gastroesophageal reflux repair were presented [18, 19].
Stapling devices for the lung and bronchus from Moscow were critiqued by Rod Taber who was a guest speaker and included the work of the Institute for Experimenting Surgical Instruments in Moscow in 1963. The largest series of resection for mucoid impaction of the bronchus [20] was presented at the Bahamas meeting in 1965 and won the "best paper" award. Tracheal fenestration for emphysema and tracheal-bronchial expiratory collapse was introduced, originally described by Nissen and popularized by Rainer and Urschel.
Many people presented their first paper at the STSA because there was not enough room on the AATS program, which then was the only other forum. Jim Brooks presented his initial paper at Ocho Rios, Jamaica, on pulmonary torsion of the left upper lobe of the lung. In 1960 Paulson and Shaw discussed the treatment of superior pulmonary sulcus carcinomas after preoperative irradiation and resection [21]—another landmark observation and presented first at the STSA (the first patient operated on successfully in 1953). Doctor Joe Miller, President of the Southern Thoracic Surgical Association at its 50th anniversary, presented a follow-up of resection of superior sulcus carcinoma and confirmed Shaw and Paulson's 5-year survival of more than 30% [22]. (This paper won the Best Scientific Paper Award in 1978.) Dr Edward (Eddie) Parker, who became famous for therapy of carcinoma of the esophagus, presented his first paper in 1960 at the STSA on the subject.
Experimental surgical research was encouraged early in the history of the STSA and included such subjects as a blood filter, pulmonary surfactant, pulmonary angiograms for pulmonary emboli followed by pulmonary embolectomy, adult respiratory distress syndrome, and reexpansion pulmonary edema. Experimental studies on the surgical laser surfaced in 1965 as well as various treatments for achalasia of the esophagus in puppies and giant cell carcinoma of the lung. Treatment of malignant pleural effusion by closed chest drainage and chemicals was noted [23]. Doctors Watts Webb, E. Converse Pierce, Olser Abbott, Lewis Bosher, and many others were prolific supporters of investigative "bench to bedside" translational research.
The interest of early Southern thoracic surgeons in emphysema predates the lung volume reduction work pioneered in St. Louis during a time in the second 25 years. The first paper presented at the STSA on this subject was by Dr Robert Shaw in the 1950s and it addressed hypertophic pulmonary emphysema in children. In 1961 Dr Osler Abbott presented a paper on selective lung reconstruction for obstructive hypertrophic pulmonary emphysema, and the role of surgery in bullous emphysema was discussed by several Southern surgeons [24].
Transplantation of the lung and heart was discussed in 1963 by Dr George Magovern who was the guest speaker; the panel discussing the subject was moderated by Lewis Bosher and included Dr Watts Webb, who had extensive experience with Dr James Hardy at the University of Mississippi. Hyperbaric oxygenation was presented by Dr R. Adams Cowley, one of the later founders of The Society of Thoracic Surgeons (STS) and the guest speaker in 1965. Doctor Ivan Brown continued the discussion in the Bahamas.
In 1965 the program was evenly divided between cardiovascular and thoracic papers for the first time. By 1967 there was a preponderance of cardiac papers over thoracic papers and from then on it was more difficult to have thoracic papers accepted for the program because of the plethora of cardiovascular research.
At the 14th Meeting in Dallas in 1967, Drs Ferguson and Burford of St. Louis presented a paper reviewing their experience with neurovascular compression at the superior aperture of the thoracic outlet emphasizing the importance of resecting the first rib as the most curative procedure in 12 cases. At the Washington, DC, meeting the management of thoracic outlet syndrome, a paper by Drs Keshishian and Smythe, recommended a transaxillary resection of the first rib for better results. In Washington, DC, Osler Abbott presided and a large demonstration by minorities partially obstructed the meeting. Thoracic outlet syndrome became a favorite subject over the years and many of the major advances, including reoperation, were initially presented at the STSA meetings [25].
Pediatric general thoracic surgery was well represented in the early years. One of the future presidents, Dr Alex Haller, was a frequent presenter and author. His experience with pectus excavatum in 254 children was the basis of a presentation in 1977 [26]. Pectus excavatum was also discussed by another president, Dr Milton Davis [27]. Pectus repair and constrictive developments of chest wall reconstructions at an early age were debated by Robiscek [28] and Cooper. Poland's syndrome [29] was discussed and many Southern surgeons have contributed to the advancement of the treatment of esophageal atresia.
A tradition of the STSA has been the contributions made by the presidents to the many meetings. All of the early presidents contributed papers on general thoracic subjects. In addition to those already mentioned, prolific contributors included Dr Edward Munnell, Dr Robert Cordell, Dr Glenn Young, Dr Joe Peabody, Dr Francis Cole, and Dr Robert Ellison.
Don Paulson, the third president of the STSA, was also president of the STS and AATS. Figure 1 shows him as chairman of the American Board of Thoracic Surgery (ABTS) in 1971 along with STSA President Ellison and member Wheat.
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Acknowledgments
The author would like to express his gratitude to Carolyn E. Reed, MD, for her review, critique, and extensive assistance in preparing this manuscript as well as her many significant contributions to thoracic surgery.
References
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