Exploring the perioptome: the role of genomics in thoracic surgery and anaesthesia

PURPOSE OF REVIEW: Genetic variation almost certainly affects every aspect of a patient's perioperative experience, yet almost nothing is known of the details involved. This review introduces the concept of static and dynamic genetic variation as a determinant of outcome after thoracic surgery and discusses some of the methodological issues involved in its study. Using a systems biology approach, it explores the ways in which data from many sources may be integrated into a common model of disease risk and outcome prediction. RECENT FINDINGS: The incidence of mortality and morbidity after lung resection is unacceptably high, and has changed little in the last 20 years. New approaches to this problem are required if we are to improve outcomes after thoracic surgery. SUMMARY: Patients seem to be predisposed to respond to a surgical stimulus in heterogeneous fashion, and this may be partly explained by variability in the genetic background with which they present for surgery. Although recent pilot data suggest that this is indeed the case, much more work remains to be done before this can be confirmed.