Intraoperative conversion during video-assisted thoracoscopy does not constitute a treatment failure†

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Video-assisted thoracoscopic surgery (VATS) is increasingly used for lung cancer resection.
• Intraoperative conversion to thoracotomy may be necessary during VATS procedures.
• The safety of VATS with conversion compared to open thoracotomy requires evaluation.

Purpose of the Study:

• To compare morbidity and mortality rates of VATS with conversion versus full VATS and open thoracotomy for anatomical lung cancer resection.
• To determine if the surgical approach is a risk factor for 90-day postoperative mortality.

Main Methods:

• Retrospective, single-center study of 610 patients undergoing anatomical pulmonary resection (January 2011-January 2017).
• Patients were divided into full VATS, VATS with conversion, and open thoracotomy groups.
• Propensity score adjustment was used to assess 90-day mortality and morbidity, controlling for confounding factors.

Main Results:

• VATS with conversion group had higher rates of comorbidities and early-stage tumors compared to open thoracotomy.
• No significant difference in 90-day postoperative mortality (5.4% VATS+conversion vs. 3.7% open thoracotomy; P=0.58).
• Similar morbidity rates were observed between VATS with conversion and open thoracotomy groups; surgical approach was not a risk factor for mortality.

Conclusions:

• VATS with intraoperative conversion to thoracotomy is a safe approach for anatomical lung cancer resection, with similar early postoperative morbidity and mortality to open thoracotomy.
• VATS should be the preferred approach, as it offers potential benefits and is not disadvantageous if conversion is required.