Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis

  • Celal Bugra Sezen
  • Salih Bilen
  • Cem Emrah KalafatEmail author
  • Levent Cansever
  • Yaşar Sonmezoglu
  • Umut Kilimci
  • Mustafa Vedat Dogru
  • Yunus Seyrek
  • Celalettin Ibrahim Kocaturk
Original Article



The aim of this study was to discuss indications and outcomes for conversion to thoracotomy during thoracoscopic lobectomy.

Materials and methods

Patients who underwent lobectomy for non-small cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. The study included 129 patients who underwent video-assisted thoracoscopic lobectomy (group-V) and 18 patients converted from thoracoscopic lobectomy to thoracotomy due to unexpected intraoperative complications (group-T).


The two patient groups showed no statistical differences in terms of demographic characteristics. Causes of unexpected conversions to thoracotomy were hemorrhage in six patients, dense pleural adhesions in seven patients, fused fissure in one patient, and fibrocalcified lymph nodes around the vascular structures in four patients. Operative time was 180.37 ± 68.6 min in group-V and 235 ± 72.6 min in group-T (p = 0.003). Intraoperative blood loss was 263.9 ± 180.6 mL in group-V, compared to 562.7 ± 296.2 mL in group-T (p < 0.001). Patient age ≥ 70 years was a significant risk factor for conversion to thoracotomy (p = 0.015, odds ratio 4.73). The 5-year survival rate in group-V was 71.4% {mean: 65.2 months [95% confidence interval (CI) 59.6–70.8]}, while that in group-T was 80% [mean 54.9 months (95% CI 45.9–63.8)] (p = 0.548).


Advanced age was identified as the main risk factor for conversion to thoracotomy. However, early- and long-term outcomes were similar in the two groups, indicating that video-assisted thoracoscopic surgery is a safe and applicable method.


VATS Thoracic surgery Conversion to thoracotomy Thoracotomy 



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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Celal Bugra Sezen
    • 1
  • Salih Bilen
    • 1
  • Cem Emrah Kalafat
    • 2
    Email author
  • Levent Cansever
    • 1
  • Yaşar Sonmezoglu
    • 1
  • Umut Kilimci
    • 1
  • Mustafa Vedat Dogru
    • 1
  • Yunus Seyrek
    • 1
  • Celalettin Ibrahim Kocaturk
    • 3
  1. 1.Department of Thoracic SurgeryYedikule Chest Diseases and Thoracic Surgery Education and Research HospitalIstanbulTurkey
  2. 2.Department of Thoracic SurgeryMardin State HospitalMardinTurkey
  3. 3.Department of Thoracic SurgeryIstinye University Medical Faculty, Liv Hospital UlusIstanbulTurkey

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