Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy.
Surg Endosc. 2019 Dec;33(12):3953-3962. doi: 10.1007/s00464-019-06682-5. Epub 2019 Jan 31.
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.
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.
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.
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.
本研究旨在分析从胸腔镜手术（VATS）转为开胸手术的原因和影响，确定任何可能的术前危险因素及相关后果。
对参与胸腔镜手术组的中心行 VATS 肺叶切除术（VATS-L）治疗非小细胞肺癌（NSCLC）的患者数据进行回顾性分析，并分为两组：接受 VATS-L 治疗的患者和转为开胸手术的患者。使用单变量和多变量精确逻辑回归评估转化率的预测因素。在 Cox 多变量逻辑回归模型中，并发症作为转化率的因变量进行评估。
共有 4629 例患者接受计划行 VATS-L 治疗 NSCLC，其中 432 例（9.3%）需要转为开胸手术；最常见的原因是出血（30.4%）和纤维钙化性肺门淋巴结（23.9%）。多变量分析模型中的独立危险因素为男性（OR 1.458，p<0.01）、年龄大于 70 岁（OR 1.248，p=0.036）和临床淋巴结阳性疾病（OR 2.258，p<0.01）。死亡率相似，但发生任何并发症的患者比例（41.7%比 24.4%，p<0.01）、并发症发生率（65%比 32.2%，p<0.01）、胸腔引流管留置时间（p<0.01）和住院率（p<0.01）均较高。心房颤动（OR 1.471，p=0.019）、持续漏气（OR 1.403，p=0.043）、输血（OR 4.820，p<0.01）、痰潴留（OR 1.80，p=0.027）和急性肾衰竭（OR 2.758，p=0.03）在多变量分析中与转化率显著相关。
转为开胸手术与手术发病率增加、失血和住院时间延长有关。男性、年龄较大和淋巴结受累是转化的最强预测因素。
