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Background and Objective: In thoracic surgery, different modalities of extracorporeal life support (ECLS) can be used for cardiorespiratory support in complex scenarios. Decades of learning in clinical practice and physiology associated with technological development led to a great variety of ECLS technologies available. Thoracic surgery procedures with difficult or impossible single lung ventilation may still be performed using different ECLS modalities. The aim of this review is to describe the use of ECLS, with its different modalities, as a solution to perform complex surgeries in a patient with difficult or impossible single lung ventilation., Methods: A literature review was conducted using the terms "extracorporeal life support pulmonary resection" and "extracorporeal life support thoracic surgery", and articles were selected according to defined criteria., Key Content and Findings: To support lung function during thoracic surgery, the most efficient and popular variety of ECLS is venovenous extracorporeal membrane oxygenation. Lung resection on a single lung after pneumonectomy, surgery in a patient with severe hypercapnia and/or low respiratory reserve, carinal and airway surgery, and severe thoracic trauma are the main examples of situations where ECLS may be the solution to provide a safe surgical environment in patients who cannot tolerate single lung ventilation. Multidisciplinarity, selection of patients and careful surgical planning are cornerstones in defining the situations that may benefit from ECLS support., Conclusions: Knowledge on techniques of ECLS are essential for every thoracic surgeon. Although rarely used, these techniques of cardiorespiratory support should be considered when planning complex cases with difficulties in ventilation and emergent situations., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1364/coif). The series “Extracorporeal Life Support in Thoracic Surgery” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2023 Journal of Thoracic Disease. All rights reserved.)

Background: Registering details of thoracic surgical activity has a long tradition in Hungary. Implemented first as a procedure based register, characteristics of the treatment, complications and outcomes has been noted for the last three decades. Although the limitations of the used database hindered the scientific analysis in the dataset and restricted the possibility of benchmarking. The European Society of Thoracic Surgeons (ESTS) database is offering a specialty-specific, procedure-specific, web-based electronic database for data contribution enabling international comparisons. Our aim was to accommodate and implement the ESTS database as the new Hungarian national thoracic surgical registry., Methods: In 2014, cooperation of the ESTS Database Committee and the Hungarian Society of Thoracic Surgery evolved a new structure for contributing national thoracic surgical data, called the ESTS database "Hungarian model". The European dataset was translated into Hungarian, extended questionnaire and continuous data access helped the completion of the dataset. The "Hungarian model" was incorporated into the common practice of all the thoracic surgical centers in Hungary., Results: In the first year of its implementation the "Hungarian model" of the ESTS dataset became the platform to use for contributing thoracic surgical data in Hungary. All the data included in the dataset were completed and periodically analyzed to form the annual Hungarian report ("the Hungarian Silver Book"). The dataset is permanently accessible for national scientific analysis and serves as a basis for quality improvement intentions., Conclusions: The Hungarian model proved to be able to serve as a national database. The complete dataset of the thoracic activity has become eligible for scientific analysis and international benchmarking, highlighting the most important core messages of the ESTS database project of improving quality and patient safety thoracic surgeons. By creating a framework for a national registry the system is incorporating an alternative for other thoracic surgical societies., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Histological characteristics and clinical behaviour define lung neuroendocrine tumors (NETs), which are classified into four groups: typical (TC) and atypical carcinoids (AC), large-cell neuroendocrine carcinomas (LCNCs) and small-cell lung cancers (SCLCs). Historically, outcome and treatment of these rare neoplasms have been based on small, usually mono-institutional clinical series. Furthermore, their rarity makes quite impossible to design randomised clinical trial to compare different treatments especially in unusual clinical presentations. In 2012, the European Society of Thoracic Surgeons (ESTS) launched a new working-group, specifically dedicated to lung NETs, with the aim to develop modern knowledge on biology and behaviour of these tumors, and to disseminate it within the scientific community. A dedicated retrospective database was at first developed and sent to all the ESTS centres interested to this project. More than 2,000 operated NETs cases have been rapidly collected, and they represented the clinical substrate of several published scientific studies. The retrospective data collection intrinsic limitations in term of patients' selection and treatment, along with the problem of possible missing data, were the reasons why the ESTS NETs working-group decided in 2015 to design and promote a new prospective database, employing the official ESTS platform. The aim of this review paper is to report the ESTS Lung NETs working-group history and to explain the architecture and use of the lung NETs databases., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

To improve standardization of general thoracic surgery (GTS) practice across Europe, the European Society of Thoracic Surgeons (ESTS) has implemented a program of Institutional Accreditation. We reviewed the methods and rules of engagement of this program. A composite performance score (CPS) including outcome and process indicators is used to measure institutional performance and assess eligibility for accreditation. Eligible units are invited to participate and accept a local audit performed by an external auditors team composed by data inspectors and thoracic surgeons. In addition to data quality, a series of structural, procedural and qualification characteristics are inspected. Once the visit is complete, the team will produce an audit report to be sent to the members of the database committee for deliberation on the institutional accreditation of that unit. The Database committee will send an executive report to the ESTS Executive Committee for their final decision on the accreditation.

The European Society of Thoracic Surgeons (ESTS) Database is a free registry created by ESTS in 2001. The current online version was launched in 2007. It runs currently on a Dendrite platform with extensive data security and frequent backups. The main features are a specialty-specific, procedure-specific, prospectively maintained, periodically audited and web-based electronic database, designed for quality control and performance monitoring, which allows for the collection of all general thoracic procedures. Data collection is the "backbone" of the ESTS database. It includes many risk factors, processes of care and outcomes, which are specially designed for quality control and performance audit. The user can download and export their own data and use them for internal analyses and quality control audits. The ESTS database represents the gold standard of clinical data collection for European General Thoracic Surgery. Over the past years, the ESTS database has achieved many accomplishments. In particular, the database hit two major milestones: it now includes more than 235 participating centers and 70,000 surgical procedures. The ESTS database is a snapshot of surgical practice that aims at improving patient care. In other words, data capture should become integral to routine patient care, with the final objective of improving quality of care within Europe.