The effect of the surgeon’s experience on perioperative complications during videothoracoscopic lobectomies in patients with stage I—II lung cancer

Background. In the initial stages of lung cancer, videothoracoscopic lobectomy (VTL) has proven itself to be an effective, low-traumatic and safe intervention. Objective. To study the experience of performing VTL using the method of constructing learning curves and determine the minimum volume of lobectomies with an acceptable level of complications. Material and methods. The study included 58 cases of anatomical lobectomies for stage I-II non-small cell lung cancer performed by one surgeon. The average age of the patients was 65.5 [57.2; 70.0] years. Cumulative sum (CUSUM) and regression models were used to analyze the learning curve. Intra- and postoperative complications were selected as signs of the experience. Regression was applied to study the minimum volume of lobectomies performed, the reference points of its construction were the number of lobectomies performed by the surgeon in 6 months. Results. Intraoperative complications were recorded in 6 (10.3%) patients, including 5 bleeding from the branches of the pulmonary artery with an average blood loss of 540 ml. The duration of the surgeon’s training on this basis was 29 operations with 2 complications. Postoperative complications occurred in 4 people: hemothorax, pneumothorax, prolonged leakage of air from the pleural cavity and hydropneumothorax. The treatment consisted in repeated drainage of the pleural cavity in 2 people and in 2 videothoracoscopic intervention: hemostasis and pleurodesis in the 2nd. During the training period, which amounted to 31 interventions, postoperative complications occurred in 3 people. The minimum number of VTL lobectomies with a complication rate of 10%, there were 24 operations per year. Conclusion. The most common intraoperative complications in VTL are bleeding from branches of the pulmonary artery, from postoperative complications — pneumothorax and air drainage. The training period for signs of complications was 29 and 31 interventions, the doctor must perform at least 24 operations per year in order to maintain technical skills and an acceptable level of complications