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| Learning curves for Video-Assisted Thoracic Surgery lobectomy in non-small cell lung cancer | |
Hyun-Sung Lee, Byung-Ho Nam, Jae Ill Zo; Center for Lung Cancer, National Cancer Center, Goyang, Gyeonggi, Korea, South
Methods: This study analyzed data from 126 consecutive patients undergoing VATS lobectomy for lung cancer between 2005 and 2008. VATS lobectomy was defined as anatomical resection without rib spreading using utility incision(figure 1). Mediastinal lymph node dissection was routinely performed. The learning curves were generated using moving average method to assess changes in operation time and cumulative sum(CUSUM) analysis to assess changes in failure rates [failure=conversion to open surgery, major perioperative complications or mortality, or prolonged operation time over 6 hours]. Also, the learning curve was generated according to the operation sites. Results: Mean age was 61 years old and male was 64 patients(51%). Adenocarcinoma was 93 patients(74%) with 2.7cm in mean size of tumor. The mean number of harvested lymph nodes was 27 in eight nodal stations. Mean operation time was 206 minutes. Failure occurred in 10 cases. The overall open conversion rate was 3.2%. There was only one postoperative mortality(0.8%). Learning curves generated using CUSUM analysis based on a 90% success rate showed that adequate learning occurred after 29 cases(Figure 2). Learning curves generated with the moving average method indicated that the operation time reached a steady state after 45 cases. During right sided VATS lobectomy, learning curves generated using CUSUM analysis showed that adequate learning occurred after 37 cases. The operation time reached a steady state after 54 cases within 3 hours During left sided VATS lobectomy, learning curves showed that adequate learning occurred after 20 cases. The operation time reached a steady state after 42 cases within 3 hours(Figure 3). Conclusion: Pertinent learning curves for VAS lobectomy for lung cancer can be generated using the moving average method and CUSUM analysis. Adequate learning for VATS lobectomy occurs around 30 cases and a steady operation time within 3 hours can be achieved around 50 cases. These results are likely to be useful in designing VATS training programs and clinical trials aimed at investigating outcomes of VATS lobectomy for lung cancer. 
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