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Causes, predictors and consequences of conversion from VATS to open lung lobectomy

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Abstract

Background

To analyze causes, predictors and consequences of conversions from intended VATS lobectomy to open surgery.

Methods

This is a retrospective analysis of a prospectively maintained database.

Results

From 2009 until December 2012, 232 patients were scheduled for anatomical VATS resection. Conversion to open surgery was necessary in 15 (6.5 %) patients. Reasons for conversion were bleeding in six, oncologic in five and technical in four patients (adhesions after pleuritis or radiotherapy for other tumors: 3; limited space: 1). In a univariable exact logistic regression analysis, conversion rate was significantly higher in patients after induction therapy (p = 0.019). There was also a statistical trend to a higher conversion rate in patients with larger tumor size (<3 vs. ≥3 cm, p = 0.117) and during the first half of our series (p = 0.107). Conversion rate was not influenced by patient age, nodal stage (pN0 vs. pN+), body mass index, the presence of chronic obstructive pulmonary disease, lung function (FEV1) or benign disease. In a multivariable exact logistic regression, induction treatment (p = 0.013) and tumor size (p = 0.04) were independent significant risk factors for conversion. Conversion did not translate into higher overall postoperative complication rate (33.3 vs. 29.5 %), longer chest drain duration (median, 5 vs. 5 days) or in-hospital mortality (0 vs. 1 %). However, length of hospital stay was significantly longer in the conversion group (median 11 vs. 9 days, p = 0.028).

Conclusions

Induction therapy was an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Following induction therapy, patients should be carefully selected for a VATS approach. Conversion to thoracotomy did not increase the postoperative rate of complications or mortality, but significantly increased length of hospital stay.

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Acknowledgements

The authors would like to thank Mrs. Mary Heaney Margreiter for proofreading the manuscript.

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Authors and Affiliations

  1. Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Florian Augustin, Herbert Thomas Maier, Annemarie Weissenbacher, Caecilia Ng, Paolo Lucciarini, Dietmar Öfner & Thomas Schmid

  2. Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schöpfstrasse 41/1, 6020, Innsbruck, Austria

    Hanno Ulmer

Authors
  1. Florian Augustin
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  2. Herbert Thomas Maier
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  3. Annemarie Weissenbacher
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  4. Caecilia Ng
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  5. Paolo Lucciarini
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  6. Dietmar Öfner
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  7. Hanno Ulmer
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  8. Thomas Schmid
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Corresponding author

Correspondence to Florian Augustin.

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Disclosures

Augustin Florian, Maier Herbert, Weissenbacher Annemarie, Ng Caecilia, Lucciarini Paolo, Öfner Dietmar, Hanno Ulmer, and Schmid Thomas have no conflicts of interest or financial ties to disclose.

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Augustin, F., Maier, H.T., Weissenbacher, A. et al. Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surg Endosc 30, 2415–2421 (2016). https://doi.org/10.1007/s00464-015-4492-3

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  • DOI: https://doi.org/10.1007/s00464-015-4492-3

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