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Conversion to Thoracotomy During Thoracoscopic vs Robotic Lobectomy: Predictors and Outcomes.

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Conversion to thoracotomy during minimally invasive lobectomy for lung cancer is more frequent with video-assisted thoracoscopic surgery (VATS) than robotic-assisted thoracoscopic surgery (RATS). While RATS conversions are more emergent, overall mortality and major complications are similar between VATS and RATS.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Minimally Invasive Procedures

Background:

  • Conversion to thoracotomy during minimally invasive lobectomy for lung cancer is occasionally necessary.
  • Differences between video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) lobectomy conversion have not been described.

Purpose of the Study:

  • To describe differences between VATS and RATS lobectomy conversion rates, reasons, and outcomes.
  • To identify predictors of conversion for both VATS and RATS lobectomy.

Main Methods:

  • Analysis of The Society of Thoracic Surgeons General Thoracic Surgery Database (2015-2018).
  • Inclusion of 27,695 minimally invasive lobectomies, excluding prior thoracic operations and metastatic disease.
  • Univariable and multivariable logistic regression analyses were performed.

Main Results:

  • Conversion occurred in 11.0% of VATS vs. 6.0% of RATS lobectomies (P < .001).
  • RATS conversions were more emergent and for vascular injury, but overall major complications and mortality were similar.
  • Lower volume centers had increased conversion rates for both VATS and RATS.

Conclusions:

  • Conversion from VATS or RATS to open lobectomy is associated with increased morbidity and mortality.
  • While VATS conversion is more frequent, RATS conversion is more emergent, with similar overall complication and mortality rates.
  • Predictors and reasons for conversion differ between VATS and RATS, aiding patient selection.