Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database
Abstract
Objective The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying
any possible pre-operative risk factors and related consequences.
Methods Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres
were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion.
Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications
were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model.
Results A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the
most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors
at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70 years (OR 1.248, p = 0.036) and the
clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered
from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration
(p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019),
prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027)
and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis.
Conclusions Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and
the clinical involvement of lymph nodes were the strongest predictors of conversion.