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

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Video-assisted thoracoscopic lobectomy (VATS) is increasingly used for non-small cell lung cancer (NSCLC).
• Conversion to thoracotomy during VATS lobectomy may be necessary due to intraoperative complications.
• Understanding the indications and outcomes of conversion is crucial for patient management.

Purpose of the Study:

• To evaluate the indications for conversion to thoracotomy during thoracoscopic lobectomy for NSCLC.
• To compare the outcomes between patients who underwent uncomplicated thoracoscopic lobectomy and those converted to thoracotomy.

Main Methods:

• Retrospective analysis of 147 patients with NSCLC undergoing lobectomy (January 2012 - December 2016).
• 129 patients underwent VATS lobectomy (group-V), and 18 were converted to thoracotomy (group-T).
• Demographic data, operative details, complications, and survival rates were compared between groups.

Main Results:

• Hemorrhage, dense pleural adhesions, fused fissures, and fibrocalcified lymph nodes were main reasons for conversion.
• Group-T had longer operative times (235 vs. 180 min) and greater blood loss (563 vs. 264 mL) compared to group-V (p<0.003).
• Advanced age (≥70 years) was a significant risk factor for conversion (OR 4.73, p=0.015).
• Five-year survival rates were similar: 71.4% in group-V and 80% in group-T (p=0.548).

Conclusions:

• Advanced age is a primary risk factor necessitating conversion from thoracoscopic to open thoracotomy during lobectomy.
• Despite longer operative times and increased blood loss in converted cases, early and long-term outcomes are comparable.
• Video-assisted thoracoscopic surgery is a safe and applicable approach for NSCLC, even with potential for conversion.