Department of Thoracic Surgery-Hôpital Nord-APHM-Aix-Marseille University, Marseille, France.
Department of Thoracic Surgery-Amiens University Hospital, Amiens, France.
Eur J Cardiothorac Surg. 2022 Aug 3;62(3). doi: 10.1093/ejcts/ezac249.
Intraoperative conversion from video-assisted thoracic surgery (VATS) to thoracotomy may occur during anatomical lung resection. The objectives of the present study were to identify risk factors for intraoperative conversion and to develop a predictive score.
We performed a multicentre retrospective analysis of French thoracic surgery departments that contributed data on anatomical lung resections to the Epithor database over a 10-year period (from January-2010 to December-2019). Using univariate and multivariate logistic regression analyses, we determined risk factors for intraoperative conversion and elaborated the Epithor conversion score (ECS). The ECS was then validated in a cohort of patients operated on between January- and June-2020.
From January-2010 to December-2019, 210,037 patients had been registered in the Epithor database. Of these, 55,030 had undergone anatomical lung resection. We excluded patients who had upfront a thoracotomy or robotic-assisted thoracoscopic surgery (n = 40,293) and those with missing data (6,794). Hence, 7943 patients with intent-to-treat VATS were assessed: 7100 with a full VATS procedure and 843 patients with intraoperative conversion to thoracotomy (conversion rate: 10.6%). Thirteen potential risk factors were identified among patients' preoperative characteristics and planned surgical procedures and were weighted accordingly to give the ECS. The score showed acceptable discriminatory power (area under the curve: 0.62 in the development cohort and 0.64 in the validation cohort) and good calibration (P = 0.23 in the development cohort and 0.30 in the validation cohort).
Thirteen potential preoperative risk factors were identified, enabling us to develop and validate the ECS-an easy-to-use, reproducible tool for estimating the risk of intraoperative conversion during VATS.
在解剖性肺切除术中，电视辅助胸腔镜手术（VATS）可能需要转为开胸手术。本研究的目的是确定术中转换的危险因素，并制定预测评分。
我们对参与 Epithor 数据库的法国胸外科部门进行了一项多中心回顾性分析，该数据库在 10 年内（2010 年 1 月至 2019 年 12 月）收集了解剖性肺切除术的数据。我们使用单变量和多变量逻辑回归分析确定了术中转换的危险因素，并制定了 Epithor 转换评分（ECS）。然后，在 2020 年 1 月至 6 月期间接受手术的患者队列中对 ECS 进行了验证。
从 2010 年 1 月至 2019 年 12 月，Epithor 数据库共登记了 210037 例患者。其中，55030 例行解剖性肺切除术。我们排除了那些一开始就进行开胸手术或机器人辅助胸腔镜手术的患者（n=40293）和那些数据缺失的患者（n=6794）。因此，对 7943 例有全 VATS 手术意向的患者进行了评估：7100 例患者行全 VATS 手术，843 例患者术中转为开胸手术（转换率：10.6%）。在患者术前特征和计划手术中确定了 13 个潜在的危险因素，并根据这些因素的权重赋予 ECS 评分。该评分显示出可接受的区分能力（在开发队列中的曲线下面积为 0.62，在验证队列中的曲线下面积为 0.64）和良好的校准度（在开发队列中的 P=0.23，在验证队列中的 P=0.30）。
确定了 13 个潜在的术前危险因素，使我们能够开发和验证 ECS，这是一种用于估计 VATS 术中转换风险的简单易用、可重复使用的工具。
