Huang Yizhou, Chen Maohui, Zhang Shuliang, Zeng Taidui, Huang Guanglei, Zheng Bin, Chen Chun
Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, China.
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Front Oncol. 2023 Feb 9;13:1072697. doi: 10.3389/fonc.2023.1072697. eCollection 2023.
Combined subsegmental surgery (CSS) is considered to be a safe and effective resection modality for early-stage lung cancer. However, there is a lack of a clear definition of the technical difficulty classification of this surgical case, as well as a lack of reported analyzes of the learning curve of this technically demanding surgical approach.
We performed a retrospective study of single-port thoracoscopic CSS performed by the same surgeon between April 2016 and September 2019. The combined subsegmental resections were divided into simple and complex groups according to the difference in the number of arteries or bronchi which need to be dissected. The operative time, bleeding and complications were analyzed in both groups. Learning curves were obtained using the cumulative sum (CUSUM) method and divided into different phases to assess changes in the surgical characteristics of the entire case cohort at each phase.
The study included 149 cases, including 79 in the simple group and 70 in the complex group. The median operative time in the two groups was 179 min (IQR, 159-209) and 235 min (IQR, 219-247) p < 0.001, respectively. And the median postoperative drainage was 435 mL (IQR, 279-573) and 476 mL (IQR, 330-750), respectively, with significant differences in postoperative extubation time and postoperative length of stay. According to the CUSUM analysis, the learning curve for the simple group was divided by the inflection point into 3 phases: Phase I, learning phase (1st to 13th operation); Phase II, consolidation phase (14th to 27th operation), and Phase III, experience phase (28th to 79th operation), with differences in operative time, intraoperative bleeding, and length of hospital stay in each phase. The curve inflection points of the learning curve for the complex group were located in the 17th and 44th cases, with significant differences in operative time and postoperative drainage between the stages.
The technical difficulties of the simple group of single-port thoracoscopic CSS could be overcome after 27 cases, while the technical ability of the complex group of CSS to ensure feasible perioperative outcomes was achieved after 44 operations.
联合亚段切除术（CSS）被认为是早期肺癌一种安全有效的切除方式。然而，对于该手术病例的技术难度分类缺乏明确的定义，并且对于这种技术要求较高的手术方式的学习曲线也缺乏报道分析。
我们对同一位外科医生在2016年4月至2019年9月期间进行的单孔胸腔镜CSS进行了回顾性研究。根据需要解剖的动脉或支气管数量的差异，将联合亚段切除术分为简单组和复杂组。分析两组的手术时间、出血量和并发症情况。使用累积和（CUSUM）方法获得学习曲线，并分为不同阶段，以评估每个阶段整个病例队列的手术特征变化。
该研究纳入149例病例，其中简单组79例，复杂组70例。两组的中位手术时间分别为179分钟（IQR，159 - 209）和235分钟（IQR，219 - 247），p < 0.001。术后中位引流量分别为435毫升（IQR，279 - 573）和476毫升（IQR，330 - 750），术后拔管时间和术后住院时间有显著差异。根据CUSUM分析，简单组学习曲线的拐点将其分为3个阶段：第一阶段，学习阶段（第1至13次手术）；第二阶段，巩固阶段（第14至27次手术）；第三阶段，经验阶段（第28至79次手术），各阶段手术时间、术中出血量和住院时间存在差异。复杂组学习曲线的拐点位于第17例和第44例，各阶段手术时间和术后引流量有显著差异。
单孔胸腔镜CSS简单组在27例手术后可克服技术困难，而复杂组CSS在44例手术后可实现确保围手术期可行结果的技术能力。
