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- Title
Causes, predictors and consequences of conversion from VATS to open lung lobectomy.
- Authors
Augustin, Florian; Maier, Herbert; Weissenbacher, Annemarie; Ng, Caecilia; Lucciarini, Paolo; Öfner, Dietmar; Ulmer, Hanno; Schmid, Thomas; Maier, Herbert Thomas; Öfner, Dietmar
- Abstract
<bold>Background: </bold>To analyze causes, predictors and consequences of conversions from intended VATS lobectomy to open surgery.<bold>Methods: </bold>This is a retrospective analysis of a prospectively maintained database.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
CHEST endoscopic surgery; LOBECTOMY (Lung surgery); LAPAROSCOPIC surgery; LUNG cancer treatment; ENDOSCOPIC surgery
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2016, Vol 30, Issue 6, p2415
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-015-4492-3