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01-12-2019 | NSCLC

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

Authors: Stefano Bongiolatti, Alessandro Gonfiotti, Domenico Viggiano, Sara Borgianni, Leonardo Politi, Roberto Crisci, Carlo Curcio, Luca Voltolini, Italian VATS Group

Published in: Surgical Endoscopy | Issue 12/2019

Abstract

Objective

The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences.

Methods

Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model.

Results

A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70 years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis.

Conclusions

Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversion.

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Title: Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database
Authors: Stefano Bongiolatti
Alessandro Gonfiotti
Domenico Viggiano
Sara Borgianni
Leonardo Politi
Roberto Crisci
Carlo Curcio
Luca Voltolini
Italian VATS Group
Publication date: 01-12-2019
Publisher: Springer US
Keywords: NSCLC
NSCLC
Thoracotomy
Published in: Surgical Endoscopy / Issue 12/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06682-5

At a glance: The STEP trials

Springer Medicine

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

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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