The 2021 annual report by the Japanese Association for Thoracic Surgery (JATS) provides an overview of thoracic and cardiovascular surgeries in Japan. The report highlights the impact of the COVID-19 pandemic on surgical volumes and outcomes. In 2021, a total of 63,054 cardiovascular surgeries were performed, including 59 heart transplants, representing a 1.6% decrease from 2020. Data showed a decline in congenital heart disease, valvular heart disease, and ischemic heart procedures, while thoracic aortic aneurysm surgeries increased. Hospital mortality rates for open heart surgeries for complex congenital heart disease remained stable over the past decade. Valvular heart disease procedures, excluding transcatheter procedures, decreased compared to the previous year, while the use of bioprosthesis increased significantly. CABG procedures decreased slightly, but hospital mortality rates remained relatively stable. In general thoracic surgery, 88,027 procedures were performed in 2021, a 2.1-fold increase compared to 2000. Primary lung cancer surgeries increased by 2.6% compared to 2020 but decreased compared to 2019. VATS procedures increased by 1.4%, with a high proportion of procedures being performed. For esophageal surgery, 5755 patients underwent surgery for esophageal diseases, with a significant decrease compared to 2019 and 2020, largely influenced by the pandemic. The most common tumor location for malignant esophageal diseases was the thoracic esophagus, with esophagectomy being the primary treatment. Minimally invasive esophagectomy (MIE) became more common, with hospital mortality rates remaining low. The report emphasizes the importance of continued data collection and collaboration with other institutions to improve surgical outcomes and understand the impact of the pandemic on thoracic and cardiovascular surgeries in Japan.The 2021 annual report by the Japanese Association for Thoracic Surgery (JATS) provides an overview of thoracic and cardiovascular surgeries in Japan. The report highlights the impact of the COVID-19 pandemic on surgical volumes and outcomes. In 2021, a total of 63,054 cardiovascular surgeries were performed, including 59 heart transplants, representing a 1.6% decrease from 2020. Data showed a decline in congenital heart disease, valvular heart disease, and ischemic heart procedures, while thoracic aortic aneurysm surgeries increased. Hospital mortality rates for open heart surgeries for complex congenital heart disease remained stable over the past decade. Valvular heart disease procedures, excluding transcatheter procedures, decreased compared to the previous year, while the use of bioprosthesis increased significantly. CABG procedures decreased slightly, but hospital mortality rates remained relatively stable. In general thoracic surgery, 88,027 procedures were performed in 2021, a 2.1-fold increase compared to 2000. Primary lung cancer surgeries increased by 2.6% compared to 2020 but decreased compared to 2019. VATS procedures increased by 1.4%, with a high proportion of procedures being performed. For esophageal surgery, 5755 patients underwent surgery for esophageal diseases, with a significant decrease compared to 2019 and 2020, largely influenced by the pandemic. The most common tumor location for malignant esophageal diseases was the thoracic esophagus, with esophagectomy being the primary treatment. Minimally invasive esophagectomy (MIE) became more common, with hospital mortality rates remaining low. The report emphasizes the importance of continued data collection and collaboration with other institutions to improve surgical outcomes and understand the impact of the pandemic on thoracic and cardiovascular surgeries in Japan.