Division of Thoracic and Cardiovascular Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts; Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts.
Section of Thoracic Surgery, Cancer Treatment Centers of America, Medical College of Georgia/Augusta University, Augusta, Georgia.
Ann Thorac Surg. 2022 Aug;114(2):409-417. doi: 10.1016/j.athoracsur.2021.10.067. Epub 2021 Dec 16.
Conversion to thoracotomy during minimally invasive lobectomy for lung cancer is occasionally necessary. Differences between video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) lobectomy conversion have not been described.
We queried The Society of Thoracic Surgeons General Thoracic Surgery Database from January 1, 2015 to December 31, 2018. Patients with prior thoracic operations and metastatic disease were excluded. Univariable comparisons with χ and Kruskal-Wallis tests and multivariable logistic regression modeling were performed.
There were 27,695 minimally invasive lobectomies from 269 centers. Conversion to thoracotomy occurred in 11.0% of VATS and 6.0% of RATS (P < .001). Conversion was associated with increased mortality (P < .001), major complications (P < .001), and intraoperative (P < .001) and postoperative (P < .001) blood transfusions. Conversion from RATS occurred emergently (P < .001) and for vascular injury (P < .001) more frequently than from VATS, but there was no difference in overall major complications or mortality. Mortality after conversion was 3.1% for RATS and 2.2% for VATS (P = .24). Clinical cancer stage II or III (P < .001), preoperative chemotherapy (P = .003), forced expiratory volume in 1 second (P = .006), body mass index (P < .001), and left-sided resection (P = .0002) independently predicted VATS conversion. For RATS clinical stage III (P = .037), left-sided resection (P = .041), and forced expiratory volume in 1 second (P = .002) predicted conversion. Lower volume centers had increased rates of conversion (P < .001) in both groups.
Conversion from minimally invasive to open lobectomy is associated with increased morbidity and mortality. Conversion occurs more frequently during VATS compared with RATS, albeit less often emergently, and with similar rates of overall mortality and major complications. Predictors, urgency, and reasons for conversion differ between RATS and VATS lobectomy and may assist in patient selection.
在微创肺叶切除术中偶尔需要转为开胸手术。但尚未描述视频辅助胸腔镜手术（VATS）和机器人辅助胸腔镜手术（RATS）肺叶切除术转换之间的差异。
我们从 2015 年 1 月 1 日至 2018 年 12 月 31 日查询了胸外科医师学会（STS）普通胸外科数据库。排除了有既往胸部手术和转移性疾病的患者。使用 χ 和 Kruskal-Wallis 检验进行单变量比较，并进行多变量逻辑回归建模。
269 个中心共进行了 27695 例微创肺叶切除术。VATS 中转开胸的比例为 11.0%，RATS 中转开胸的比例为 6.0%（P<.001）。转换与死亡率增加（P<.001）、主要并发症（P<.001）、术中（P<.001）和术后（P<.001）输血有关。RATS 中转开胸更常因血管损伤（P<.001）而紧急进行（P<.001），但总体主要并发症或死亡率无差异。RATS 中转开胸的死亡率为 3.1%，VATS 为 2.2%（P=0.24）。临床癌症分期 II 或 III 期（P<.001）、术前化疗（P=0.003）、1 秒用力呼气量（P=0.006）、体重指数（P<.001）和左侧切除（P=0.0002）独立预测 VATS 中转开胸。对于 RATS，临床分期 III 期（P=0.037）、左侧切除（P=0.041）和 1 秒用力呼气量（P=0.002）预测了转换。低容量中心在两组中均有更高的转化率（P<.001）。
从微创转为开胸肺叶切除术与发病率和死亡率增加有关。与 RATS 相比，VATS 中转开胸更常见，但紧急程度较低，总死亡率和主要并发症发生率相似。RATS 和 VATS 肺叶切除术之间的转化率、紧急程度和原因不同，这可能有助于患者选择。
