Worse outcomes after conversion of thoracoscopic lobectomy for lung cancer. (22nd November 2020)

• Record Type: Journal Article
• Authors: Gabryel, Piotr; Piwkowski, Cezary; Kasprzyk, Mariusz; Zieliński, Paweł; Roszak, Magdalena; Dyszkiewicz, Wojciech
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 32:Number 3(2021)
• Page Start: 356
• Page End: 363
• Publication Date: 2020-11-22
• Subjects: Lobectomy -- Lung cancer -- Minimally invasive surgery -- Thoracoscopy/video-assisted thoracoscopic surgery -- Conversion; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivaa274
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Conversion of thoracoscopic lobectomy for lung cancer to thoracotomy can adversely affect short-term outcomes, but the impact on long-term outcomes is unknown. This study aimed to identify the risk factors for conversion and to determine the influence of conversion on the outcomes of lung cancer treatment. METHODS: This retrospective study included 1002 consecutive patients with lung cancer who underwent thoracoscopic lobectomy between 7 June 1999 and 17 July 2018. The groups of patients with and without conversion were compared in terms of possible risk factors and the short- and long-term outcomes. The survival of patients was analysed by the Kaplan–Meier method. RESULTS: Conversion was done in 105 patients (10.5%). On multivariable logistic regression analysis, the independent risk factors for conversion were pleural adhesions ( P < 0.001) and mediastinal lymph node metastases ( P < 0.001). Compared with the non-conversion group, the conversion group had longer chest drainage time (4 vs 3 days, P < 0.001) and hospital stay (8 vs 6 days, P < 0.001); more frequent complications (38.1% vs 27.1%, P = 0.018), including red blood cell transfusion (10.5% vs 2%, P < 0.001) and supraventricular arrhythmia (13.3% vs 7.5%, P = 0.037); and lower 5-year survival rate in patients with stage I lung cancer (70% vs 87%, P = 0.014). Conversion did not increase in-hospital mortality. CONCLUSIONS: Pleural adhesions and lymph node metastases increased the probability of conversion to thoracotomy. Conversion adversely affected the short-term outcomes of thoracoscopic lobectomy. Long-term outcomes of treatment of non-small-cell lung cancer could be worse in patients after conversion, but definitive conclusions cannot be made in this regard because of the absence of control of selection bias. Abstract : The first pulmonary lobectomy with video thoracoscopic assistance was performed by Roviaro et al . [1] in 1991.