Structured training and early outcomes in major pulmonary resections by a junior thoracic surgeon: a retrospective observational study

Background: The early learning curve of junior thoracic surgeons is not well characterized, despite evidence that proficiency in video-assisted thoracoscopic surgery (VATS) lobectomy often requires 50–60 cases. This study assessed the surgical progression and outcomes of a single junior thoracic surgeon during the first three years of independent practice, focusing on major pulmonary resections and the integration of segmentectomy. Methods: We retrospectively reviewed all thoracic operations performed by a single surgeon from June 2022 to June 2025. A total of 123 patients were included, encompassing primary lung cancer, pulmonary metastasis, and infectious disease. Quarterly trends in operative time, blood loss, and case volume were assessed, with particular focus on major pulmonary resections (lobectomy and anatomical segmentectomy). Perioperative outcomes were compared between procedures. For cumulative sum (CUSUM) analysis, only patients with primary lung cancer who underwent anatomical segmentectomy or lobectomy (n=113) were analyzed. Results: Among 402 operations, 123 were major pulmonary resections (75 lobectomies, 48 segmentectomies). Major resection volume increased steadily, with segmentectomy comprising 46% by 2025. Mean operative time decreased from 207.5 to 152.6 minutes, and blood loss from >200 to ~80 mL. Compared to lobectomy, segmentectomy showed shorter operative (139.8 vs. 175.0 minutes, P<0.001) and anesthesia times, less blood loss (42.1 vs. 94.1 mL, P<0.001), and shorter hospital stays (7.0 vs. 10.3 days, P=0.02), with no significant difference in complication or mortality rates. CUSUM analysis identified procedure-specific turning points at the 26th lobectomy and 16th segmentectomy, indicating earlier proficiency in segmentectomy despite its greater technical complexity. Conclusions: A structured, stepwise approach—including assistantship, gradual case complexity, and cognitive preparation—enabled safe and efficient early-career outcomes in major pulmonary resections. These findings highlight the value of combined technical training and institutional perioperative support in facilitating the transition to independent surgical practice.