Predictors of conversion to thoracotomy during video-assisted thoracoscopic surgery lobectomy in lung cancer: additional predictive value of FDG-PET/CT in a tuberculosis endemic region

Abstract

Conclusions: The addition of FDG PET/CT scanning to chest CT imaging provides better performance for predicting conversion to thoracotomy during VATS lobectomy in lung cancer patients. Therefore, in lung cancer patients undergoing surgical resection, FDG PET/CT can provide additional reliable information in selecting the appropriate surgical approach for a lobectomy.

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

“…In our study, intraoperative blood loss and open thoracotomy, which have not been described previously, were found to be important factors affecting the decision to admit patients to the ICU. Intraoperative blood loss, open thoracotomy, pleural adhesion, and major vessel injury are closely related to each other [15,16,17,18,22,23,24,25]. In our univariable regression analysis, pleural adhesion and major vessel injury were also found to be risk factors for mandatory ICU admission.…”

“…The most common causes of conversion to thoracotomy are unexpected bleeding, which is usually associated with vessel injury (the pulmonary artery and vein), anatomical problems including pleural adhesion, or incomplete interlobar fissure, and oncological conditions such as parietal pleural invasion, or positive margins [15,16,17,18,22,23,24,25]. Unexpected intraoperative bleeding is a relatively rare but life-threatening complication in lung resection; thus, it could be a great concern for thoracic surgeons [19,33], and most of them are due to major vessel injury [24].…”

Development and Validation of a 18F-FDG PET/CT-Based Clinical Prediction Model for Estimating Malignancy in Solid Pulmonary Nodules Based on a Population With High Prevalence of Malignancy

“…Among patients who underwent CT screening in China, the reported incidence rate of calcified nodules was 16.1% (1099/6830). 28 Among patients who underwent lobectomy via planned video-assisted thoracoscopic surgery for primary lung cancer in South Korea, 29 the incidence rates of calcified lung nodule and pleural calcification were 27.7% (65/235) and 8.1% (19/235), respectively. A mathematical model was deduced with an AUC of 0.858 in the training set and 0.809 in the validation set.…”

The relativity of operative time on the outcomes of the video-assisted thoracoscopic lobectomies

“…Several studies evaluated the role of imaging studies in predicting conversion, revealing that hilar lymph node calcification on preoperative chest CT is a likelihood of conversion. There is a relationship between not only the presence of calcified lymph node and conversion but also the peribronchial fibrosis with anthracotic pigmentation and the risk of conversion (8).…”