Augustin Florian, Maier Herbert Thomas, Weissenbacher Annemarie, Ng Caecilia, Lucciarini Paolo, Öfner Dietmar, Ulmer Hanno, Schmid Thomas
Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schöpfstrasse 41/1, 6020, Innsbruck, Austria.
Surg Endosc. 2016 Jun;30(6):2415-21. doi: 10.1007/s00464-015-4492-3. Epub 2015 Sep 3.
To analyze causes, predictors and consequences of conversions from intended VATS lobectomy to open surgery.
This is a retrospective analysis of a prospectively maintained database.
From 2009 until December 2012, 232 patients were scheduled for anatomical VATS resection. Conversion to open surgery was necessary in 15 (6.5 %) patients. Reasons for conversion were bleeding in six, oncologic in five and technical in four patients (adhesions after pleuritis or radiotherapy for other tumors: 3; limited space: 1). In a univariable exact logistic regression analysis, conversion rate was significantly higher in patients after induction therapy (p = 0.019). There was also a statistical trend to a higher conversion rate in patients with larger tumor size (<3 vs. ≥3 cm, p = 0.117) and during the first half of our series (p = 0.107). Conversion rate was not influenced by patient age, nodal stage (pN0 vs. pN+), body mass index, the presence of chronic obstructive pulmonary disease, lung function (FEV1) or benign disease. In a multivariable exact logistic regression, induction treatment (p = 0.013) and tumor size (p = 0.04) were independent significant risk factors for conversion. Conversion did not translate into higher overall postoperative complication rate (33.3 vs. 29.5 %), longer chest drain duration (median, 5 vs. 5 days) or in-hospital mortality (0 vs. 1 %). However, length of hospital stay was significantly longer in the conversion group (median 11 vs. 9 days, p = 0.028).
Induction therapy was an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Following induction therapy, patients should be carefully selected for a VATS approach. Conversion to thoracotomy did not increase the postoperative rate of complications or mortality, but significantly increased length of hospital stay.
分析意向性电视辅助胸腔镜肺叶切除术转为开胸手术的原因、预测因素及后果。
这是一项对前瞻性维护数据库的回顾性分析。
2009年至2012年12月期间，232例患者计划接受解剖性电视辅助胸腔镜切除术。15例（6.5%）患者需要转为开胸手术。转为开胸手术的原因包括6例出血、5例肿瘤学相关原因及4例技术相关原因（胸膜炎或其他肿瘤放疗后的粘连：3例；空间受限：1例）。在单变量精确逻辑回归分析中，诱导治疗后的患者转化率显著更高（p = 0.019）。肿瘤较大（<3 cm与≥3 cm，p = 0.117）的患者以及本系列前半段的患者转化率也有统计学上更高的趋势（p = 0.107）。转化率不受患者年龄、淋巴结分期（pN0与pN+）、体重指数、慢性阻塞性肺疾病的存在、肺功能（FEV1）或良性疾病的影响。在多变量精确逻辑回归中，诱导治疗（p = 0.013）和肿瘤大小（p = 0.04）是转为开胸手术的独立显著危险因素。转为开胸手术并未导致更高的总体术后并发症发生率（33.3%对29.5%）、更长的胸腔引流时间（中位数，5天对5天）或住院死亡率（0对1%）。然而，转为开胸手术组的住院时间显著更长（中位数11天对9天，p = 0.028）。
在本电视辅助胸腔镜肺叶切除术系列中，诱导治疗是转为开胸手术的独立危险因素。诱导治疗后，应仔细选择患者进行电视辅助胸腔镜手术。转为开胸手术并未增加术后并发症发生率或死亡率，但显著增加了住院时间。
