Reference : Conversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lu...
Scientific journals : Article
Human health sciences : Surgery
http://hdl.handle.net/10993/45780
Conversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lung resection: how does it affect perioperative outcomes?
English
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 mailto [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]
25-Nov-2020
Interactive Cardiovascular and Thoracic Surgery
Elsevier
Yes (verified by ORBilu)
International
1569-9293
1569-9285
Netherlands
[en] Video-assisted thoracic surgery ; Conversion ; Lung resection
[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%).
Researchers ; Professionals
http://hdl.handle.net/10993/45780
10.1093/icvts/ivaa220

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