Miyazaki Takuro, Imperatori Andrea, Jimenez Marcelo, Drosos Polivios, Gomez-Hernandez Maria T, Varela Gonzalo, Novoa Nuria, Nagayasu Takeshi, Brunelli Alessandro
Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Interact Cardiovasc Thorac Surg. 2019 May 1;28(5):728-734. doi: 10.1093/icvts/ivy319.
The purpose of this study was to develop a score to predict the complexity of video-assisted thoracoscopic surgery (VATS) lobectomies preoperatively.
One hundred and thirty-nine consecutive patients undergoing VATS lobectomy operated on by a single surgeon as the first operator were included. Complex operations were defined as: operation time >180 min (corresponding to the 75th percentile) or a conversion to thoracotomy. Several patient-related baseline and radiological variables were tested for a possible association with surgical complexity by logistic regression analysis. An aggregate score was created by weighing the regression estimates of the significant predictors. Patients were then grouped in classes of risk according to their scores. Finally, the score was validated in an external population of 154 VATS lobectomy patients.
Twenty-nine VATS lobectomies (21%) were classified as complex. The following variables were found to be significantly associated with a complex operation and were used to calculate the risk score in each patient (1 point each): male (P = 0.006), presence of thick pleura (P = 0.003), presence of emphysema (P = 0.001), enlarged hilar nodes (P = 0.003). Patients were grouped in 4 classes showing an incremental incidence of complex operations (P < 0.0001): score 0, 7.4%; score 1, 18%; score 2, 27%; score >2, 67%. In the external validation set, the score confirmed its association with the incidence of complex operations (P < 0.001): score 0, 7.3%; score 1, 10%; score 2, 16%; score >2 50%.
The complexity score appeared to be reproducible in an external setting and can be used to preoperatively identify appropriate candidates for VATS lobectomies to improve the efficiency and safety of the training phase.
本研究的目的是制定一个评分系统，用于术前预测电视辅助胸腔镜手术（VATS）肺叶切除术的复杂性。
纳入139例由同一位外科医生作为第一术者进行VATS肺叶切除术的连续患者。复杂手术定义为：手术时间>180分钟（对应第75百分位数）或转为开胸手术。通过逻辑回归分析测试了几个与患者相关的基线和放射学变量与手术复杂性的可能关联。通过权衡显著预测因素的回归估计值创建了一个综合评分。然后根据患者的评分将其分为不同风险类别。最后，在154例VATS肺叶切除术患者的外部人群中对该评分进行了验证。
29例VATS肺叶切除术（21%）被归类为复杂手术。发现以下变量与复杂手术显著相关，并用于计算每位患者的风险评分（每项1分）：男性（P = 0.006）、胸膜增厚（P = 0.003）、肺气肿（P = 0.001）、肺门淋巴结肿大（P = 0.003）。患者被分为4类，显示复杂手术的发生率逐渐增加（P < 0.0001）：评分0，7.4%；评分1，18%；评分2，27%；评分>2，67%。在外部验证组中，该评分证实了其与复杂手术发生率的关联（P < 0.001）：评分0，7.3%；评分1，10%；评分2，16%；评分>2，50%。
复杂性评分在外部环境中似乎具有可重复性，可用于术前识别适合VATS肺叶切除术的患者，以提高培训阶段的效率和安全性。
