Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes

Abstract

Objective: We aimed to identify predictors of conversion to thoracotomy and test the hypothesis that conversion is associated with inferior perioperative outcomes in non-small cell lung cancer (NSCLC). Methods: We queried the National Cancer Database for patients with stage I to III NSCLC undergoing minimally invasive surgery (MIS) during 2010 to 2016. We compared clinicopathologic factors between patients undergoing MIS with and without conversion. We fitted multivariable regression models to identify independent predictors of conversion and compare perioperative outcomes between the 2 groups. Results: A rising trend in the use of MIS was accompanied by a declining trend in the rate of conversion to thoracotomy. A total of 11.3% of the 83,219 cases were converted. Conversion was associated with a higher Charlson-Deyo score, squamous histology, nodal involvement, high tumor grade, tumor size ≥5 cm, and a higher T stage ( P < 0.05). Successful MIS without conversion was predicted by advanced age, sublobar resection, robotic approach, and treatment at an academic high-volume facility ( P < 0.05). Conversion was linked to longer hospital stays, higher 30-day and 90-day mortality, and unplanned readmission ( P < 0.05), irrespective of the type of MIS approach. Conclusions: Conversion rates for video-assisted and robot-assisted thoracoscopic surgery have seen a decline in recent years. Irrespective of the type of MIS approach, conversion was associated with inferior perioperative outcomes. The robotic approach and treatment at an academic high-volume facility were associated with a lower likelihood of conversion. Early recognition of the individual risk factors for conversion may help to counsel patients about the likelihood of, and detriments associated with, conversion and ultimately reduce conversion rates.

Short-term outcomes of robot-assisted versus video-assisted thoracoscopic surgery for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a single-center retrospective study

“…This conclusion is aligned with many previous publications enrolling early-stage or locally advanced NSCLC cases (23,24,39). However, at least four research revealed that fewer patients who received RATS converted to thoracotomy when compared with those undergoing VATS (27,(40)(41)(42).…”

“…This conclusion is aligned with many previous publications enrolling early-stage or locally advanced NSCLC cases ( 23 , 24 , 39 ). However, at least four research revealed that fewer patients who received RATS converted to thoracotomy when compared with those undergoing VATS ( 27 , 40 – 42 ). Importantly, RATS was also found to reduce conversion incidence for NSCLC patients with neoadjuvant immunochemotherapy than VATS ( 43 ).…”

The impact of social determinants of health on textbook oncological outcomes and overall survival in locally advanced non–small cell lung cancer

“…This is consistent with a previous study indicating inferior outcomes in NSCLC. 28 Hospital volume in the top 5th percentile decreased mortality risk by 31%, and increased TOO likelihood by 93% as compared to low-volume hospitals. This highlights the role of surgeon competence and experience, as disadvantaged patients may lack access to facilities with NSCLC volume and proper MIS experience.…”

A Systematic Review of Short-Term Outcomes of Minimally Invasive Thoracoscopic Surgery for Lung Cancer after Neoadjuvant Systemic Therapy

“…This finding is consistent with a retrospective National Cancer Database analysis that found neoadjuvant chemotherapy to be associated with a higher conversion rate of 18.3% than those without neoadjuvant treatment with a p < 0.01. In contrast, Muslim et al found neoadjuvant treatment was not an independent predictor of conversion [38]. Comparatively, a meta-analysis of early-stage NSCLC without neoadjuvant treatment found a median conversion rate of 8.1% (range 0-15.7%) [8].…”