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Updated: Sep 26, 2025
05:39
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
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Patient risk factors for conversion during video-assisted thoracic surgery-the Epithor conversion score
Alex Fourdrain1, Olivier Georges2, Dominique Gossot3
1Department of Thoracic Surgery-Hôpital Nord-APHM-Aix-Marseille University, Marseille, France.
Summary
Intraoperative conversion from video-assisted thoracic surgery (VATS) to thoracotomy occurs in 10.6% of anatomical lung resections. A new Epithor conversion score (ECS) identifies 13 preoperative risk factors to predict VATS conversion.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Intraoperative conversion from VATS to thoracotomy is a known complication during anatomical lung resection.
- Predicting and mitigating this conversion is crucial for optimizing surgical outcomes and patient safety.
Purpose of the Study:
- To identify risk factors associated with intraoperative conversion from VATS to thoracotomy.
- To develop and validate a predictive score for estimating the likelihood of such conversions.
Main Methods:
- A multicentre retrospective analysis of anatomical lung resections from the Epithor database (2010-2019).
- Univariate and multivariate logistic regression analyses were used to identify risk factors.
- The Epithor Conversion Score (ECS) was developed and validated on a separate patient cohort.
Main Results:
- The study included 7943 patients undergoing anatomical lung resection with intent-to-treat VATS; 10.6% required intraoperative conversion to thoracotomy.
- Thirteen preoperative risk factors were identified and incorporated into the ECS.
- The ECS demonstrated acceptable discriminatory power (AUC 0.62-0.64) and good calibration in both development and validation cohorts.
Conclusions:
- The Epithor Conversion Score (ECS) is a validated, easy-to-use tool for estimating the risk of intraoperative conversion during VATS.
- Identifying these risk factors can aid surgeons in preoperative planning and patient counseling.
- Further research may explore refining the ECS for improved predictive accuracy.
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