| Contributors: |
Bongiolatti; aEmail Author, S.; Gonfiotti, A. a.; Viggiano, D. a.; Borgianni, S. a.; Politi, L. a.; Crisci, R. b.; Curcio, C. c.; Voltolini, L. a.; Amore, D.; Marulli, G.; Nicotra, S.; Negri, De; Maineri, A.; Rienzo, Di; Lopez, G.; Divisi, C.; Morelli, D.; Bertani, A.; Russo, A.; Londero, E.; Rosso, F.; Spaggiari, L.; Gasparri, L.; Baietto, R.; Casadio, G.; Infante, C.; Benato, M.; Alloisio, C.; Bottoni, M.; Droghetti, E.; Giovanardi, A.; Cardillo, Assunta; Carleo, G.; Bertolaccini, F.; Solli, L.; Stella, Paride; Dolci, F.; Puma, Giorgia; Vinci, F.; Cavallesco, D.; Maniscalco, G.; Argnani, P.; Ampollini, D.; Carbognani, L.; Terzi, P.; Viti, A.; Negri, A.; Bandiera, G.; Perkmann, A.; Zaraca, R.; Ibrahim, F.; Poggi, ANNA MARIA; Camplese, C.; Luzzi, P.; Ghisalberti, L.; Imperatori, M.; Rotolo, A.; Bortolotti, N.; Rizzardi, L.; Torre, G.; Rinaldo, M.; Sabbatini, A.; Refai, A.; Benvenuti, Marco; Benetti, M. R.; Stefani, D.; Natali, Alessandro; Lausi, P.; Guerrera, P.; Italian VATS Group; Mucilli, F |
| Description: |
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 |