Video-assisted thoracoscopic surgery lobectomy for lung cancer: the learning curve

Video-assisted thoracoscopic surgery (VATS) lobectomy is an acceptable alternative to open lobectomy for treating early-stage lung cancer. As with any video-assisted surgical procedure, there is a learning curve to overcome before becoming proficient. In this study, the outcomes of 90 consecutive VATS lobectomies for lung cancer were evaluated to determine the learning curve for this procedure.

A single group of surgeons performed VATS lobectomy with systematic lymph node dissection in 90 patients with lung cancer between September 2006 and January 2009. The patients were divided equally and chronologically into three groups: group A, group B, and group C; group A was the earliest group of patients treated. Clinical data were collected. The operative time, blood loss, number of dissected mediastinal lymph nodes and nodal stations, conversion rate to thoracotomy, postoperative complications, duration of chest drainage, and hospital stay duration were compared between the three groups.

There were no differences between the three groups with respect to age, gender, size of tumor, pathological stage, and operative procedure. The operative time and blood loss were significantly lower in groups B and C than in group A (P < 0.01); however, there were no differences between groups B and C. There were no differences among the groups in the number lymph nodes harvested, conversion rate, postoperative complications, duration of chest drainage, or hospital stay duration.

A learning curve for VATS lobectomy existed in this series. The surgeon became more proficient after 30-60 cases and was able to perform the procedure with decreased blood loss and operative time.