Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database

Bongiolatti, Stefano; Gonfiotti, Alessandro; Viggiano, Domenico; Borgianni, Sara; Politi, Lucia; Crisci, Roberto; Curcio, Carlo; Voltolini, Luca; Amore, Dario; Marulli, Giuseppe; Nicotra, Samuele; Negri, A. De; Maineri, Paola; DiRienzo, G.; López, Claudia Luján; Divisi, Duilio; Morelli, Angelo; Bertani, Alessandro; Russo, Emanuele; Londero, Francesco; Rosso, Lorenzo; Spaggiari, Lorenzo; Gasparri, Roberto; Baietto, Guido; Casadio, Caterina; Infante, Maurizio; Benato, Cristiano; Alloisio, Marco; Bottoni, Edoardo; Droghetti, Andrea; Giovanardi, A; Cardillo, Giuseppe; Carleo, Francesco; Bertolaccini, Luca; Solli, Piergiorgio; Stella, Franco; Dolci, Giampiero; Puma, Francesco; Vinci, Danilo; Cavallesco, Giorgio; Maniscalco, Pio; Argnani, Desideria; Ampollini, Luca; Carbognani, Paolo; Terzi, Alberto; Viti, Andrea; Negri, Giampiero; Bandiera, Alessandro; Perkmann, Reinhold; Zaraca, Francesco; Ibrahim, Mohsen; Poggi, Camilla; Mucilli, Felice; Camplese, Pierpaolo; Luzzi, Luca; Ghisalberti, Marco; Imperatori, Andrea; Rotolo, Nicola; Bortolotti, Luigi; Rizzardi, Giovanna; Torre, Mari C. de la; Rinaldo, Alessandra; Sabbatini, Armando; Refai, Majed; Benvenuti, Mauro Roberto; Benetti, Diego; Stefani, A.; Natali, Pamela; Lausi, Paolo Olivo; Guerrera, Francesco

doi:10.1007/s00464-019-06682-5

Cited by 28 publications

(30 citation statements)

References 25 publications

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“…In the literature, conversion rates have been reported between 2.5%-9.3% of total VATS resections. [19,20] The most common reason is similar to our findings, perioperative hemorrhage. Other reasons are hilar fibrotic or calcific lymph nodes, adhesions, to achieve the optimal resection of the tumors, invasions of the mediastinum or chest wall, or a requirement for sleeve resections.…”

Section: Discussionsupporting

confidence: 91%

Comparison of Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non Small Cell Lung Cancer - 269 Cases Single Cohort Study

Erdoğu¹

2020

Sisli Etfal

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M any centers worldwide perform lobectomy by video-assisted thoracoscopic surgery (VATS) as an alternative to open thoracotomy in suitable cases, especially in early stage non-small cell lung cancer (NSCLC) cases. [1] According to many studies, the advantages of VATS lobectomy compared to conventional open thoracotomy include shorter length of hospitalization, less postoperative complications, shorter duration of the chest tube, a more cosmetic incision, less postoperative pain, therefore better postoperative life quality and importantly similar overall survival rates compared to open thoracotomy. [2-4] VATS resections have become increasingly popular worldwide following the improvements in training programmes, drawing young surgeons' interest in VATS lobectomy, leading to increased experience. [5] In our Thoracic Surgery Clinic, VATS lobectomy is being performed since the beginning of the 2010s. VATS experience of Objectives: This study aims to compare the outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy with open thoracotomy lobectomy in patients with non-small cell lung cancer (NSCLC). Methods: There were 269 cases with NSCLC who underwent lobectomy between 2017-2019; these cases were retrospectively studied. VATS lobectomy (VATS Group) and open thoracotomy lobectomy (Thoracotomy Group) patients' results were compared according to the length of hospitalizations, early postoperative complications and tumor size and stages. Results: VATS lobectomy was performed in 89 (33%) of these patients, whereas 180 (67%) patients underwent lobectomy using open thoracotomy for NSCLC. The findings showed that the average length of hospitalization was shorter in the VATS Group compared to the Thoracotomy Group (4 vs. 5.5 days) (p<0.05). It was found that the mean size of the tumour was smaller in the VATS Group when compared to the Thoracotomy Group (2.66 cm vs 3.97 cm) (p<0.001). Early postoperative complications were lower in the VATS Group (n=15, 16.8% vs n=58, 32.2%; p<0.021). Conclusion: In VATS lobectomy cases, postoperative complications are less, and the length of hospitalization is shorter. VATS lobectomy is mostly preferred smaller than 3 cm tumor size.

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Section: Discussionsupporting

confidence: 91%

Comparison of Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non Small Cell Lung Cancer - 269 Cases Single Cohort Study

Erdoğu¹

2020

Sisli Etfal

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“…However, there is a potential risk with thoracoscopic lobectomy that unexpected emergency thoracotomy may be required because of a major intraoperative complication. This has been reported to occur in 2.5%–23% of cases, and is associated with several complications, including atrial fibrillation, prolonged air leak, the need for blood transfusion, sputum retention, and acute kidney failure . The rate of conversion to thoracotomy (1.2%) in our study was lower than that of previous reports, perhaps because of selection bias in the patients.…”

Section: Discussioncontrasting

confidence: 70%

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non‐small cell lung cancer

et al. 2019

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Background Minimally invasive thoracoscopic lobectomy is the recommended surgery for clinical stage I non‐small cell lung cancer (NSCLC). The purpose of this study was to identify the risk factors, including sarcopenia, for postoperative complications in patients undergoing a complete single‐lobe thoracoscopic lobectomy for clinical stage I NSCLC, as well as the impact of complications on disease‐free survival. Methods We retrospectively investigated 173 patients with pathologically‐diagnosed NSCLC who underwent curative thoracoscopic lobectomies between April 2013 and March 2018. Sarcopenia was assessed using the psoas muscle index calculated from preoperative computed tomography images at the third lumbar vertebral level. Results Complications developed in 38 (22%) patients, including 21 with prolonged air leak. In univariate analysis, the significant risk factors for complications were advanced age, male sex, higher Charlson Comorbidity Index (CCI) score, lower cholinesterase, lower albumin, higher creatinine level, pleural adhesion, operative time ≥ five hours, nonadenocarcinoma cancer, and larger tumor size. Multivariate analysis showed that age ≥ 75 years (P = 0.002) and pleural adhesion (P = 0.026) were significant independent risk factors for complications. Compared with the patient group without complications, postoperative complications were independently associated with shorter disease‐free survival (P = 0.01). Conclusions Advanced age and pleural adhesion were independent risk factors for complications after complete single‐lobe thoracoscopic lobectomies for clinical stage I NSCLC, and postoperative complications were statistically associated with poor prognosis. Surgical teams should ensure an experienced surgeon leads the operation for patients at higher risk to avoid prolonged postoperative hospitalization and a possible poor prognosis.

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“…Converse unidirectional RATS usually starts with opening the fissure to dissecting the hilum, which requires the pulmonary lobe with preferable fissure. For the patients with dysplasia or incomplete fissure, the incidence of conversion to thoracotomy and continuous air leakage after the operation will increase due to the large wound area caused by the opening of the pulmonary fissure (19,20). Due to the different management order of hilum, the cut and closure of pulmonary fissure tissue was performed last, thus 4-port unidirectional VATS has low requirements for the development of the pulmonary fissure and relatively less postoperative air leakage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Huang¹,

Tian²,

Zhou³

et al. 2021

Transl Lung Cancer Res

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Background: Robotic-assisted thoracic surgery (RATS) has been widely used in the treatment of lung cancer.The perioperative outcomes of right upper lobectomy (RUL) using RATS and video-assisted thoracic surgery (VATS) were retrospectively investigated and compared. We aimed to summarize a single-center experience of RATS and 4-port unidirectional VATS in RUL, and to discuss the safety and the essentials of the surgery. Methods:We retrospectively analyzed the 685 with non-small cell lung cancer (NSCLC) patients who underwent minimally invasive RUL in our center by the same surgical group from January 2015 to December 2019. Both RATS and VATS were performed with three ports with utility incision. The 685 participants were divided into RATS (335 cases) and VATS (350 cases) groups according to surgical method. Baseline characteristics and perioperative outcomes including dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, and incidence of postoperative complications were compared between the groups.Results: In the 685 patients enrolled, the baseline characteristics were comparable, and no postoperative 30-day mortality or intraoperative blood transfusion were observed. Compared with VATS, RATS had less surgical duration (90.22±12.16 vs. 92.68±12.26 min, P<0.001), less length of stay (4.71±1.37 vs. 5.26±1.56 days, P<0.001), and decreased postoperative duration of drainage (3.49±1.15 vs. 4.09±1.57 days, P<0.001). No significant difference was observed in the lymph nodes dissection, blood loss, conversion rate and morbidities.

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Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database

Cited by 28 publications

References 25 publications

Comparison of Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non Small Cell Lung Cancer - 269 Cases Single Cohort Study

Comparison of Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non Small Cell Lung Cancer - 269 Cases Single Cohort Study

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non‐small cell lung cancer

Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

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