Thoracoscopic lobectomy for early-stage non-small cell lung carcinoma: initial experience from a newly established Israeli center

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Background: Video-assisted thoracoscopic surgery (VATS) lobectomy has emerged as the standard surgical procedure for early-stage non-small cell lung cancer (NSCLC). This article presents the initial experience of a newly established thoracic surgery department with a residency program, evaluating surgical, oncologic and safety outcomes while implementing a learning environment. Methods: This single-center retrospective study analyzed medical records of patients who underwent VATS lobectomy for early-stage NSCLC between 2019 and 2024. Inclusion criteria were age over 18 years, NSCLC pathology, and clinical stage IA-IIB. The patient population was divided into two subgroups, the first consisting of procedures performed exclusively by senior surgeons and the second consisting of those performed by residents under direct supervision. Key outcomes were mortality, overall complication, and overall survival rates. Results: A total of 460 patients were evaluated, with a mean age of 69.7 years; the cohort was predominantly male. Adenocarcinoma was the most common pathology (81.1%), with right upper lobe resection being the most frequent procedure. The conversion rate to thoracotomy was 4.1%, with senior surgeons reporting a rate of 8.7% compared to 0.7% among residents. Thirty-day mortality was 1.73%, with senior surgeons at 1.02% and residents at 2.26%. Overall complication rate reached 26.7% without a difference in the subgroups. Prolonged hospitalization occurred in 26.9% of cases. Five-year overall survival was 90.42% among the 94 patients with adequate follow-up, demonstrating favorable outcomes for minimally invasive surgery in early-stage lung cancer. Conclusions: This single-center experience demonstrates that VATS lobectomy is a safe and effective treatment for early-stage NSCLC, yielding outcomes comparable to those reported globally. The study findings reaffirm VATS as a current standard of care, providing robust postoperative survival and manageable complication rates. Furthermore, study indicates that VATS lobectomy is also a safe procedure for training surgical residents, supporting its role in surgical education.

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