Reference : Conversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lu...

	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Surgery
	To cite this reference:	http://hdl.handle.net/10993/45780

Title :	Conversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lung resection: how does it affect perioperative outcomes?
Language :	English
Author, co-author :	Seitlinger, Joseph [University Hospital Strasbourg, Strasbourg, France > Department of Thoracic Surgery]
	Olland, Anne [University Hospital Strasbourg, Strasbourg, France > Department of Thoracic Surgery]
	Guinard, Sophie [University Hospital Strasbourg, Strasbourg, France > Department of Thoracic Surgery]
	Massard, Gilbert [University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) >]
	Falcoz, Pierre-Emmanuel [University Hospital Strasbourg, Strasbourg, France > Department of Thoracic Surgery]
Publication date :	25-Nov-2020
Journal title :	Interactive Cardiovascular and Thoracic Surgery
Publisher :	Elsevier
Peer reviewed :	Yes (verified by ORBilu)
Audience :	International
ISSN :	1569-9293
e-ISSN :	1569-9285
Country :	Netherlands
Keywords :	[en] Video-assisted thoracic surgery ; Conversion ; Lung resection
Abstract :	[en] Objectives: Since video-assisted thoracic surgery (VATS) was first performed in the early 1990s, there have been many developments, and the conversion rate has decreased over the years. This article highlights the specific outcomes of patients undergoing conversion to thoracotomy despite initially scheduled VATS lung resection. Methods: We retrospectively reviewed 501 patients who underwent thoracoscopic anatomic lung resection (i.e. lobectomy, segmentectomy or bilobectomy) between 1 January 2012 and 1 August 2017 at our institution. We explored the risk factors for surgical conversion and adverse events occurring in patients who underwent conversion to thoracotomy. Results: A total of 44/501 patients underwent conversion during the procedure (global rate: 8.8%). The main reasons for conversion were (i) anatomical variation, adhesions or unexpected tumour extension (37%), followed by (ii) vascular causes (30%) and (iii) unexpected lymph node invasion (20%). The least common reason for conversion was technical failure (13%). We could not identify any specific risk factors for conversion. The global complication rate was significantly higher in converted patients (40.9%) than in complete VATS patients (16.8%) (P = 0.001). Postoperative atrial fibrillation was a major complication in converted patients (18.2%) [odds ratio (OR) 5.09, 95% confidence interval (CI) 1.80-13.27; P = 0.001]. Perioperative mortality was higher in the conversion group (6.8%) than in the VATS group (0.2%) (OR 33.3, 95% CI 3.4-328; P = 0.003). Conclusions: Through the years, the global conversion rate has dramatically decreased to <10%. Nevertheless, patients who undergo conversion represent a high-risk population in terms of complications (40.9% vs 16.8%) and perioperative mortality (6.8% vs 0.2%).
Target :	Researchers ; Professionals
Permalink :	http://hdl.handle.net/10993/45780
DOI :	10.1093/icvts/ivaa220

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