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Kemp Kernstine, MD, PhD, University of Texas, Southwestern Medical Center, Division of Thoracic Surgery, explains that not all thoracic surgeries are the same and that the results of the surgery may not only depend on the surgeon but also the hospital. Kernstine believes that some institutions put a lot of investment into the quality-of-care for thoracic surgery while smaller institutions with fewer resources rely heavily on the skills of the surgeon. He urges medical oncologists to recommend their patients see surgical teams at high volume centers if local surgeons turn them down. When examining results from recent trials looking at the morbidity rates of patients receiving pneumonectomies many of the deaths are from smaller lower volume centers. For the best results it is important to have high volume specialized centers.