The Learning Curve of the Thoracic Phase in Single-Port Thoracoscopic Esophagectomy for Esophageal Cancer

Objective Single-port thoracoscopic esophagectomy is an emerging minimally invasive technique that offers potential advantages in reducing surgical trauma and accelerating postoperative recovery. However, its learning curve has not been well characterized. This study aimed to evaluate the learning curve of single-port thoracoscopic esophagectomy and to determine the number of cases required to achieve technical proficiency. Methods and analysis: A retrospective analysis was conducted on 220 patients with esophageal squamous cell carcinoma who underwent single-port thoracoscopic esophagectomy between August 2018 and December 2022 at a single center. The cumulative sum (CUSUM) method was employed to assess the learning curve based on operative time. Perioperative outcomes including operative time, intraoperative blood loss, complication rates, and postoperative recovery indicators were compared between different learning phases. Results CUSUM analysis revealed an inflection point at the 109th case, dividing the learning process into an initial phase (cases 1-109) and a proficiency phase (cases 110–220). Compared to the initial phase, the thoracic operative time was significantly reduced in the proficiency phase (67.32 ± 12.32 vs. 71.72 ± 12.15 minutes, P = 0.008), and intraoperative blood loss was also significantly decreased (96.85 ± 72.39 vs. 125.50 ± 85.50 mL, P = 0.008). Although the incidence of major complications declined in the proficiency phase (10.81% vs. 17.59%), the difference did not reach statistical significance (OR = 0.57, 95% CI: 0.26–1.24, P = 0.154). Furthermore, patients in the proficiency phase experienced lower postoperative VAS pain scores and shorter hospital stays. Conclusion Single-port thoracoscopic esophagectomy has a relatively steep learning curve, with approximately 109 cases required to reach technical proficiency. Once proficiency is achieved, significant improvements in operative efficiency and patient recovery can be observed. These findings have important implications for the training and promotion of single-port thoracoscopic esophagectomy and suggest that this surgery should be performed by surgeons with extensive thoracoscopic experience under expert guidance.