Department of Thoracic Surgery, Hôpital Nord-APHM-Aix-Marseille University, Marseille, France.
Department of Epidemiology and Health Economics, APHM, Marseille, France.
Eur J Cardiothorac Surg. 2023 Sep 7;64(3). doi: 10.1093/ejcts/ezad283.
Despite an improvement in surgical abilities, the need for an intraoperative switch from a minimally invasive procedure towards an open surgery (conversion) still remains. To anticipate this risk, the Epithor conversion score (ECS) has been described for video-assisted thoracoscopic surgery (VATS). Our objective was to determine if this score, developed for VATS, is applicable in robotic-assisted thoracoscopic surgery (RATS).
This was a retrospective monocentric study from January 2006 to June 2022, and data were obtained from the EPITHOR database. Patients included were those who underwent anatomic lung resection either by VATS or RATS. The ECS was calculated for all patients studied. Discrimination and calibration of the test were measured by the area under the curve and Hosmer-Lemeshow test.
A total of 1685 were included. There were 183/1299 conversions in the VATS group (14.1%) and 27/386 conversions in the RATS group (6.9%). Patients in the RATS group had fewer antiplatelet therapy and peripheral arterial disease. There were more segmentectomies in the VATS group. As for test discrimination, the area under the curve was 0.66 [0.56-0.78] in the RATS group and 0.64 [0.60-0.69] in the VATS group. Regarding the calibration, the Hosmer-Lemeshow test was not significant for both groups but more positive (better calibrated) for the VATS group (P = 0.12) compared to the RATS group (P = 0.08).
The ECS seems applicable for patients operated with RATS, with a correct discrimination but a lower calibration performance for patients operated with VATS. A new score could be developed to specifically anticipate conversion in patients operated on by RATS.
尽管手术能力有所提高，但仍需要将微创手术术中转为开放性手术（转换）。为了预测这种风险，已经为电视辅助胸腔镜手术（VATS）描述了 Epithor 转换评分（ECS）。我们的目的是确定该评分是否适用于机器人辅助胸腔镜手术（RATS）。
这是一项 2006 年 1 月至 2022 年 6 月的回顾性单中心研究，数据来自 EPITHOR 数据库。纳入的患者为接受解剖性肺切除术的患者，手术方式为 VATS 或 RATS。为所有研究患者计算 ECS。通过曲线下面积和 Hosmer-Lemeshow 检验来衡量测试的区分度和校准度。
共纳入 1685 例患者。VATS 组中有 183/1299 例（14.1%）转为开放手术，RATS 组中有 27/386 例（6.9%）转为开放手术。RATS 组中抗血小板治疗和外周动脉疾病患者较少。VATS 组中更多的行节段切除术。就测试的区分度而言，RATS 组的曲线下面积为 0.66 [0.56-0.78]，VATS 组为 0.64 [0.60-0.69]。关于校准，两组的 Hosmer-Lemeshow 检验均无统计学意义，但 VATS 组更为阳性（校准更好）（P=0.12），而 RATS 组则无统计学意义（P=0.08）。
ECS 似乎适用于接受 RATS 手术的患者，具有正确的区分度，但对接受 VATS 手术的患者校准性能较低。可以开发新的评分来专门预测接受 RATS 手术的患者的转换。
