title: Video-Assisted Thoracic Surgical Lobectomy for Lung Cancer: Description of a Learning Curve.
abstract: BACKGROUND
  Video-assisted thoracic surgical (VATS) lobectomy is gaining popularity in the treatment of lung cancer. The aim of this study is to investigate the learning curve of VATS lobectomy by using multidimensional methods and to compare the learning curve groups with respect to perioperative clinical outcomes.
  
  
  METHODS
  We retrospectively reviewed a prospective database to identify 67 consecutive patients who underwent VATS lobectomy for lung cancer by a single surgeon. The learning curve was analyzed by using moving average and the cumulative sum (CUSUM) method. With the moving average and CUSUM analyses for the operation time, patients were stratified into two groups, with chronological order defining early and late experiences. Perioperative clinical outcomes were compared between the two learning curve groups.
  
  
  RESULTS
  According to the moving average method, the peak point for operation time occurred at the 26th case. The CUSUM method also showed the operation time peak point at the 26th case. When results were compared between early- and late-experience periods, the operation time, duration of chest drainage, and postoperative hospital stay were significantly longer in the early-experience group (cases 1 to 26). The intraoperative estimated blood loss was significantly less in the late-experience group (cases 27 to 67). CUSUM charts showed a decreasing duration of chest drainage after the 36th case and shortening postoperative hospital stay after the 37th case.
  
  
  CONCLUSIONS
  Multidimensional statistical analyses suggested that the learning curve for VATS lobectomy for lung cancer required ∼26 cases. Favorable intraoperative and postoperative care parameters for VATS lobectomy were observed in the late-experience group.
authors.affiliation: 1 Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University , Nanjing, Jiangsu, China .
authors.forename: Fei
authors.initials: F
authors.lastname: Yao
authors.affiliation: 1 Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University , Nanjing, Jiangsu, China .
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: 1 Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University , Nanjing, Jiangsu, China .
authors.forename: Ju
authors.initials: J
authors.lastname: Yao
authors.affiliation: 1 Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University , Nanjing, Jiangsu, China .
authors.forename: Fangrong
authors.initials: F
authors.lastname: Hang
authors.affiliation: 1 Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University , Nanjing, Jiangsu, China .
authors.forename: Shiqi
authors.initials: S
authors.lastname: Cao
authors.affiliation: 2 College of International Studies, Nanjing Medical University , Nanjing, Jiangsu, China .
authors.forename: Yongke
authors.initials: Y
authors.lastname: Cao
mesh_terms: D016063:Blood Loss, Surgical; D016208:Databases, Factual; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery*; D061646:Operative Time; D011013:Pneumonectomy / Q000193:education* / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000193:education* / Q000379:methods; D016896:Treatment Outcome
keywords: learning curve; lung cancer; video-assisted thoracoscopic surgery