international put them in thousands of school busses. The busses needed no EGR and they used a ELC coolant, very few problems.
The girdle or bed plate on the 6.0 is massive, probably because of the bus application. I have never seen a piston out the side of that motor...ever. The bottom end does not go out on that motor, it can take a beating.
All late model ford trucks need the cab removed for major work, but its engineered for that. They can be off in a few hours. Most mechanics prefer it because its easier to do the repair and the job is of higher quality.
Don't buy a tuned truck and read all the material out there...there is tons of it.