Skip to main content
Erschienen in: Surgical Endoscopy 6/2016

03.09.2015

Causes, predictors and consequences of conversion from VATS to open lung lobectomy

verfasst von: Florian Augustin, Herbert Thomas Maier, Annemarie Weissenbacher, Caecilia Ng, Paolo Lucciarini, Dietmar Öfner, Hanno Ulmer, Thomas Schmid

Erschienen in: Surgical Endoscopy | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

To analyze causes, predictors and consequences of conversions from intended VATS lobectomy to open surgery.

Methods

This is a retrospective analysis of a prospectively maintained database.

Results

From 2009 until December 2012, 232 patients were scheduled for anatomical VATS resection. Conversion to open surgery was necessary in 15 (6.5 %) patients. Reasons for conversion were bleeding in six, oncologic in five and technical in four patients (adhesions after pleuritis or radiotherapy for other tumors: 3; limited space: 1). In a univariable exact logistic regression analysis, conversion rate was significantly higher in patients after induction therapy (p = 0.019). There was also a statistical trend to a higher conversion rate in patients with larger tumor size (<3 vs. ≥3 cm, p = 0.117) and during the first half of our series (p = 0.107). Conversion rate was not influenced by patient age, nodal stage (pN0 vs. pN+), body mass index, the presence of chronic obstructive pulmonary disease, lung function (FEV1) or benign disease. In a multivariable exact logistic regression, induction treatment (p = 0.013) and tumor size (p = 0.04) were independent significant risk factors for conversion. Conversion did not translate into higher overall postoperative complication rate (33.3 vs. 29.5 %), longer chest drain duration (median, 5 vs. 5 days) or in-hospital mortality (0 vs. 1 %). However, length of hospital stay was significantly longer in the conversion group (median 11 vs. 9 days, p = 0.028).

Conclusions

Induction therapy was an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Following induction therapy, patients should be carefully selected for a VATS approach. Conversion to thoracotomy did not increase the postoperative rate of complications or mortality, but significantly increased length of hospital stay.
Literatur
2.
Zurück zum Zitat Yan TD, Black D, Bannon PG, McCaughan BC (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 27:2553–2562CrossRefPubMed Yan TD, Black D, Bannon PG, McCaughan BC (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 27:2553–2562CrossRefPubMed
3.
Zurück zum Zitat Cao C, Manganas C, Ang SC, Peeceeyen S, Yan TD (2013) Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact CardioVasc Thorac Surg 16:244–249CrossRefPubMedPubMedCentral Cao C, Manganas C, Ang SC, Peeceeyen S, Yan TD (2013) Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact CardioVasc Thorac Surg 16:244–249CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Nwogu CE, D’Cunha J, Pang H, Gu L, Wang X, Richards WG, Veit LJ, Demmy TL, Sugarbaker DJ, Kohman LJ, Swanson SJ, Alliance for Clinical Trials in Oncology (2015) VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg 99:399–405CrossRefPubMed Nwogu CE, D’Cunha J, Pang H, Gu L, Wang X, Richards WG, Veit LJ, Demmy TL, Sugarbaker DJ, Kohman LJ, Swanson SJ, Alliance for Clinical Trials in Oncology (2015) VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg 99:399–405CrossRefPubMed
5.
Zurück zum Zitat Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM (2013) Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:7S–37SCrossRefPubMed Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM (2013) Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:7S–37SCrossRefPubMed
6.
Zurück zum Zitat Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J (2011) Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Surg 91:1961–1965CrossRefPubMed Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J (2011) Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Surg 91:1961–1965CrossRefPubMed
7.
Zurück zum Zitat Reichert M, Kerber S, Amati AL, Bodner J (2014) Total video-assisted thoracoscopic (VATS) resection of a left-sided sulcus superior tumor after induction radiochemotherapy: video and review. Surg Endosc. 2014 Nov 26. [Epub ahead of print] PubMed PMID: 25424366 Reichert M, Kerber S, Amati AL, Bodner J (2014) Total video-assisted thoracoscopic (VATS) resection of a left-sided sulcus superior tumor after induction radiochemotherapy: video and review. Surg Endosc. 2014 Nov 26. [Epub ahead of print] PubMed PMID: 25424366
8.
Zurück zum Zitat Puri V, Patel A, Majumder K, Bell JM, Crabtree TD, Krupnick AS, Kreisel D, Broderick SR, Patterson GA, Meyers BF (2015) Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg 149:55–61CrossRefPubMedPubMedCentral Puri V, Patel A, Majumder K, Bell JM, Crabtree TD, Krupnick AS, Kreisel D, Broderick SR, Patterson GA, Meyers BF (2015) Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg 149:55–61CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81:421–425 (discussion 425–426) CrossRefPubMed McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81:421–425 (discussion 425–426) CrossRefPubMed
10.
Zurück zum Zitat Samson P, Guitron J, Reed MF, Hanseman DJ, Starnes SL (2013) Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg 145:1512–1518CrossRefPubMed Samson P, Guitron J, Reed MF, Hanseman DJ, Starnes SL (2013) Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg 145:1512–1518CrossRefPubMed
11.
Zurück zum Zitat Billè A, Okiror L, Harrison-Phipps K, Routledge T (2014) Does Previous Surgical Training Impact the Learning Curve in Video-Assisted Thoracic Surgery Lobectomy for Trainees? Thorac Cardiovasc Surg. 2014 Dec 2. [Epub ahead of print] Billè A, Okiror L, Harrison-Phipps K, Routledge T (2014) Does Previous Surgical Training Impact the Learning Curve in Video-Assisted Thoracic Surgery Lobectomy for Trainees? Thorac Cardiovasc Surg. 2014 Dec 2. [Epub ahead of print]
12.
Zurück zum Zitat Swanson SJ, Herndon JE 2nd, D’Amico TA, Demmy TL, McKenna RJ Jr, Green MR, Sugarbaker DJ (2007) Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study. J Clin Oncol 25:4993–4997CrossRefPubMed Swanson SJ, Herndon JE 2nd, D’Amico TA, Demmy TL, McKenna RJ Jr, Green MR, Sugarbaker DJ (2007) Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study. J Clin Oncol 25:4993–4997CrossRefPubMed
13.
Zurück zum Zitat Augustin F, Schmid T, Lucciarini P, Bieck S, Bodner J (2010) Minimally invasive lung lobectomy: indication, patient selection, surgical technique and outcome. Eur Surg 42:204–208CrossRef Augustin F, Schmid T, Lucciarini P, Bieck S, Bodner J (2010) Minimally invasive lung lobectomy: indication, patient selection, surgical technique and outcome. Eur Surg 42:204–208CrossRef
14.
Zurück zum Zitat Petersen RH, Hansen HJ (2010) Learning thoracoscopic lobectomy. Eur J Cardiothorac Surg 37:516–520CrossRefPubMed Petersen RH, Hansen HJ (2010) Learning thoracoscopic lobectomy. Eur J Cardiothorac Surg 37:516–520CrossRefPubMed
15.
Zurück zum Zitat Cao C, Petersen RH, Yan TD (2014) Learning curve for video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg 147:1727CrossRefPubMed Cao C, Petersen RH, Yan TD (2014) Learning curve for video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg 147:1727CrossRefPubMed
16.
Zurück zum Zitat Flores RM, Ihekweazu U, Dycoco J, Rizk NP, Rusch VW, Bains MS, Downey RJ, Finley D, Adusumilli P, Sarkaria I, Huang J, Park B (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg 142:1412–1417CrossRefPubMed Flores RM, Ihekweazu U, Dycoco J, Rizk NP, Rusch VW, Bains MS, Downey RJ, Finley D, Adusumilli P, Sarkaria I, Huang J, Park B (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg 142:1412–1417CrossRefPubMed
17.
Zurück zum Zitat Nakashima S, Watanabe A, Hashimoto M, Mishina T, Obama T, Higami T (2011) Advantages of video-assisted thoracoscopic surgery for adult congenital hernia with severe adhesion: report of two cases. Ann Thorac Cardiovasc Surg 17:185–189CrossRefPubMed Nakashima S, Watanabe A, Hashimoto M, Mishina T, Obama T, Higami T (2011) Advantages of video-assisted thoracoscopic surgery for adult congenital hernia with severe adhesion: report of two cases. Ann Thorac Cardiovasc Surg 17:185–189CrossRefPubMed
18.
Zurück zum Zitat Berry MF, Onaitis MW, Tong BC, Balderson SS, Harpole DH, D’Amico TA (2012) Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection. Eur J Cardiothorac Surg 41:888–892CrossRefPubMedPubMedCentral Berry MF, Onaitis MW, Tong BC, Balderson SS, Harpole DH, D’Amico TA (2012) Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection. Eur J Cardiothorac Surg 41:888–892CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Demmy TL, Yendamuri S, Hennon MW, Dexter EU, Picone AL, Nwogu C (2012) Thoracoscopic maneuvers for chest wall resection and reconstruction. J Thorac Cardiovasc Surg 144:52–57CrossRef Demmy TL, Yendamuri S, Hennon MW, Dexter EU, Picone AL, Nwogu C (2012) Thoracoscopic maneuvers for chest wall resection and reconstruction. J Thorac Cardiovasc Surg 144:52–57CrossRef
20.
Zurück zum Zitat Jones RO, Casali G, Walker WS (2008) Does failed video-assisted lobectomy for lung cancer prejudice immediate and long-term outcomes? Ann Thorac Surg 86:235–239CrossRefPubMed Jones RO, Casali G, Walker WS (2008) Does failed video-assisted lobectomy for lung cancer prejudice immediate and long-term outcomes? Ann Thorac Surg 86:235–239CrossRefPubMed
21.
Zurück zum Zitat Sawada S, Komori E, Yamashita M (2009) Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. Eur J Cardiothorac Surg 36:487–490CrossRefPubMed Sawada S, Komori E, Yamashita M (2009) Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. Eur J Cardiothorac Surg 36:487–490CrossRefPubMed
22.
Zurück zum Zitat McKenna RJ Jr (2008) Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 18:275–280CrossRefPubMed McKenna RJ Jr (2008) Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 18:275–280CrossRefPubMed
23.
Zurück zum Zitat Tsitsias T, Boulemden A, Ang K, Nakas A, Waller DA (2014) The N2 paradox: similar outcomes of pre- and postoperatively identified single-zone N2a positive non-small-cell lung cancer. Eur J Cardiothorac Surg 45:882–887CrossRefPubMed Tsitsias T, Boulemden A, Ang K, Nakas A, Waller DA (2014) The N2 paradox: similar outcomes of pre- and postoperatively identified single-zone N2a positive non-small-cell lung cancer. Eur J Cardiothorac Surg 45:882–887CrossRefPubMed
Metadaten
Titel
Causes, predictors and consequences of conversion from VATS to open lung lobectomy
verfasst von
Florian Augustin
Herbert Thomas Maier
Annemarie Weissenbacher
Caecilia Ng
Paolo Lucciarini
Dietmar Öfner
Hanno Ulmer
Thomas Schmid
Publikationsdatum
03.09.2015
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 6/2016
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4492-3

Weitere Artikel der Ausgabe 6/2016

Surgical Endoscopy 6/2016 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.