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Surg Endosc. 2016 Jun;30(6):2415-21. doi: 10.1007/s00464-015-4492-3. Epub 2015 Sep 3.

Causes, predictors and consequences of conversion from VATS to open lung lobectomy.

Author information

1
Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. florian.augustin@i-med.ac.at.
2
Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
3
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schöpfstrasse 41/1, 6020, Innsbruck, Austria.

Abstract

BACKGROUND:

To analyze causes, predictors and consequences of conversions from intended VATS lobectomy to open surgery.

METHODS:

This is a retrospective analysis of a prospectively maintained database.

RESULTS:

From 2009 until December 2012, 232 patients were scheduled for anatomical VATS resection. Conversion to open surgery was necessary in 15 (6.5 %) patients. Reasons for conversion were bleeding in six, oncologic in five and technical in four patients (adhesions after pleuritis or radiotherapy for other tumors: 3; limited space: 1). In a univariable exact logistic regression analysis, conversion rate was significantly higher in patients after induction therapy (p = 0.019). There was also a statistical trend to a higher conversion rate in patients with larger tumor size (<3 vs. ≥3 cm, p = 0.117) and during the first half of our series (p = 0.107). Conversion rate was not influenced by patient age, nodal stage (pN0 vs. pN+), body mass index, the presence of chronic obstructive pulmonary disease, lung function (FEV1) or benign disease. In a multivariable exact logistic regression, induction treatment (p = 0.013) and tumor size (p = 0.04) were independent significant risk factors for conversion. Conversion did not translate into higher overall postoperative complication rate (33.3 vs. 29.5 %), longer chest drain duration (median, 5 vs. 5 days) or in-hospital mortality (0 vs. 1 %). However, length of hospital stay was significantly longer in the conversion group (median 11 vs. 9 days, p = 0.028).

CONCLUSIONS:

Induction therapy was an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Following induction therapy, patients should be carefully selected for a VATS approach. Conversion to thoracotomy did not increase the postoperative rate of complications or mortality, but significantly increased length of hospital stay.

KEYWORDS:

Conversion; Risk factor; Thoracotomy; VATS

PMID:
26335073
DOI:
10.1007/s00464-015-4492-3
[Indexed for MEDLINE]

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