Analysis of risk factors for conversion to thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer
10.7507/1007-4848.201609064
- VernacularTitle:胸膜固定术辅助治疗自发性气胸的临床研究
- Author:
LI Huawei
1
;
WANG Haiyan
2
,
3
;
ZHANG Linyou
4
Author Information
1. Department of Thoracic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453000, Henan, P.R.China
2. Department of Hepatology, No.371 Central Hospital of Chinese People&rsquo
3. s Liberation, Xinxiang, 453000, Henan, P.R.China
4. Department of Thoracic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150086, P.R.China
- Publication Type:Journal Article
- Keywords:
Video-assisted thoracic surgery;
conversion to thoracotomy;
lobectomy;
independent risk factor
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2017;24(12):962-969
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.
