Artikel
Causes, predictors and consequences of conversions in vats lobectomy
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Veröffentlicht: | 14. Oktober 2013 |
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Gliederung
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Objective: To analyze causes, predictors and consequences of conversions to open surgery in VATS lobectomy.
Methods: Retrospective analysis of a prospectively maintained database.
Results: Starting in 2009, 232 patients were scheduled for anatomical VATS resections. Conversion to open surgery was necessary in 15 patients (6.5%). Reasons for conversion were bleeding in 6, oncologic reason in 5 and technical considerations in 4 patients (adhesions after pleuritis or radiotherapy for other tumors: 3, limited space: 1). In univariate analysis, conversion rate was significantly higher in patients after neoadjuvant therapy (25% vs 4.3%, p=0.002). There was also a statistical trend for higher conversion rate in patients during the first half of the series (9.5% vs 3.4%, p=0.062) and larger tumor size (T1 vs >T1, 4.8% vs 12.9%, p=0.098). The conversion rate was not influenced by age of the patient, nodal stage (pN0 vs pN+), body mass index, COPD, FEV1, or benign disease. Conversion did not translate into higher overall postoperative complication rates (33.3% vs 29.5%), longer chest drain duration (median 5 vs 5 days), or mortality (0% vs 2%). However, length of hospital stay was significantly longer in the conversion group (median 11 vs 9 days, p=0.0066).
Conclusion: Neoadjuvant therapy is an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Patients after neoadjuvant therapy should be selected carefully for a VATS approach. Conversion to thoracotomy did not increase the postoperative complication or mortality rate, but significantly increased the length of stay.