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Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes.

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Conversion to thoracotomy during minimally invasive surgery for non-small cell lung cancer (NSCLC) is linked to worse outcomes. Factors like tumor size and nodal involvement predict conversion, while robotic approaches and high-volume centers reduce it.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Minimally invasive surgery (MIS) is increasingly used for non-small cell lung cancer (NSCLC).
  • Conversion to thoracotomy during MIS may impact patient outcomes.
  • Predictors and outcomes associated with conversion require further investigation.

Purpose of the Study:

  • To identify predictors of conversion to thoracotomy during MIS for NSCLC.
  • To evaluate the association between conversion and perioperative outcomes.

Main Methods:

  • Analysis of the National Cancer Database (2010-2016) for stage I-III NSCLC patients undergoing MIS.
  • Comparison of clinicopathologic factors between patients with and without conversion.
  • Multivariable regression models to identify predictors and compare outcomes.

Main Results:

  • Conversion rates declined with increased MIS use, with 11.3% of 83,219 cases converted.
  • Predictors of conversion included higher Charlson-Deyo score, squamous histology, nodal involvement, high tumor grade, larger tumor size (≥5 cm), and higher T stage.
  • Factors predicting successful MIS without conversion were advanced age, sublobar resection, robotic approach, and treatment at high-volume academic facilities.
  • Conversion was associated with longer hospital stays, increased 30-day and 90-day mortality, and unplanned readmissions, regardless of MIS approach.

Conclusions:

  • Conversion rates for video-assisted and robot-assisted thoracoscopic surgery are decreasing.
  • Conversion to thoracotomy is consistently linked to inferior perioperative outcomes in NSCLC.
  • Robotic approach and high-volume academic centers are associated with lower conversion rates, potentially improving patient outcomes.