Development of a video-assisted thoracoscopic lobectomy program in a single institution: Results before and after completion of the learning curve

Abstract

Background: The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases. Methods: From June 2012 to March 2015, we performed n=146 VATS major pulmonary resections: n=50 (Group A: LC); n=96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case. Results: Mean operative time was 191min (120-290) in Group A and 162min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in: pN0 disease: Group A n=44 (88%), Group B n=80 (83.4%); pN1: Group A n=3 (6%), Group B n=8 (8.3%); pN2: Group A n=3 (6%), Group B n=8 (8.3%). Conversion rate was: 8% in group A (n=4 vascular injuries); 1.1% in Group B (n=1 hilar lymph node disease). We registered n=6 (12%) complications in Group A, n=10 (10.6%) in Group B. One case (1.1%) of late post-operative mortality (90days) was registered in Group B for liver failure. Mean hospital stay was 6.5days in Group A and 5.9days in Group B. Conclusions: We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages.