Is the Epithor conversion score reliable in robotic-assisted surgery anatomical lung resection?

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Intraoperative conversion from minimally invasive to open surgery remains a challenge despite surgical advancements.
• The Epithor conversion score (ECS) was developed to predict conversions in video-assisted thoracoscopic surgery (VATS).

Purpose of the Study:

• To evaluate the applicability of the Epithor conversion score (ECS), originally designed for VATS, in predicting conversions during robotic-assisted thoracoscopic surgery (RATS).

Main Methods:

• A retrospective monocentric study analyzed data from the EPITHOR database (January 2006 to June 2022).
• Patients undergoing anatomic lung resection via VATS or RATS were included.
• The ECS was calculated, and its discrimination (Area Under the Curve) and calibration (Hosmer-Lemeshow test) were assessed.

Main Results:

• The study included 1685 patients: 1299 in the VATS group and 386 in the RATS group.
• Conversion rates were 14.1% for VATS and 6.9% for RATS.
• The ECS demonstrated correct discrimination in RATS (AUC 0.66) and VATS (AUC 0.64), with better calibration in VATS (P=0.12) than RATS (P=0.08).

Conclusions:

• The Epithor conversion score (ECS) appears applicable for RATS, showing adequate discrimination.
• Calibration performance of the ECS was lower in the RATS group compared to VATS.
• Development of a novel score specifically for RATS may be warranted to improve conversion prediction.