Marcus Taylor, Gokul Raj Krishna, Kandadai Rammohan, Eustace Fontaine, Vijay Joshi, Stuart Grant, Felice Granato
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引用次数: 0
Abstract
Background: Lung cancer resections are increasingly being performed via video-assisted thoracoscopic surgery (VATS). Conversion to thoracotomy can occur for many reasons and may affect outcomes. The objective of this study was to investigate the impact of VATS conversion on short- and mid-term outcomes and identify reasons for conversion.
Methods: Consecutive patients undergoing lobectomy for primary non-small cell lung cancer between 2012 and 2019 in a single UK center were included. Primary outcomes were 90-day mortality, intraoperative conversion, and overall survival. Reasons for conversion were defined as bleeding or nonbleeding. Outcomes were compared between groups using univariable analysis. Multivariable logistic regression analysis was performed to identify risk factors for conversion.
Results: A total of 2,622 patients were included with 20.6% (n = 541) completing surgery via VATS and 79.4% (n = 2,081) via thoracotomy. The rate of completed VATS surgery increased significantly over time (2012: 6.9%, 2019: 55.1%, p < 0.001). Overall conversion rate was 14.3% (n = 90/631) and has reduced significantly over time (p < 0.001). The rate of conversion due to intraoperative bleeding was 31.1% (n = 28/90). Obesity, male sex, and stage III disease were independent risk factors for conversion. The 90-day mortality rate after conversion was not significantly different from the rate for planned thoracotomy (3.3 vs. 3.4%, p = 0.987). There was no significant difference in overall survival between patients experiencing intraoperative conversion and those undergoing planned thoracotomy (p = 0.135).
Conclusion: This study demonstrates comparable outcomes for patients undergoing conversion from VATS to those undergoing planned surgery via thoracotomy. It remains unclear if reason for conversion is associated with outcomes.
背景:肺癌切除术越来越多地通过视频辅助胸腔镜手术(VATS)进行。转开胸手术的原因有很多，可能会影响手术结果。本研究的目的是调查VATS转换对短期和中期结果的影响，并确定转换的原因。方法:纳入2012年至2019年在单个英国中心连续接受原发性非小细胞肺癌肺叶切除术的患者。主要结局为90天死亡率、术中转换和总生存率。皈依的原因被定义为出血或不出血。采用单变量分析比较各组间结果。进行多变量logistic回归分析以确定转化的危险因素。结果:共纳入2622例患者，其中20.6% (n = 541)通过VATS完成手术，79.4% (n = 2081)通过开胸完成手术。VATS手术完成率随时间显著增加(2012年:6.9%，2019年:55.1%，p n = 90/631)，随时间显著降低(p n = 28/90)。肥胖、男性和III期疾病是转化的独立危险因素。转换后的90天死亡率与计划开胸的死亡率无显著差异(3.3 vs. 3.4%， p = 0.987)。术中转换患者与计划开胸患者的总生存率无显著差异(p = 0.135)。结论:本研究证明了VATS转换患者与计划开胸手术患者的结果相当。目前尚不清楚转换的原因是否与结果有关。
期刊介绍：
The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field.
Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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