What is difficult about doing video-assisted thoracic surgery (VATS)? A retrospective study comparing VATS anatomical resection and conversion to thoracotomy for lung cancer in a university-based hospital

Si-Wook Kim, Jong-Myeon Hong, Dohun Kim


Background: To analyze causes and clinical outcomes of conversion to thoracotomy during video-assisted thoracic surgery (VATS) anatomical resection for patients with non-small cell lung cancer.
Methods: A total of 245 consecutive pulmonary resections were performed from January 2013 to July 2016 at Chungbuk National University Hospital. Patients who underwent curative, anatomical resection for lung cancer were included in the study. Preoperative basal characteristics, functional factors, radiologic findings and clinical outcomes were compared between converted and non-converted patients.
Results: Of the 245 patients, 91 (benign disease) and 17 (non-anatomical resection) were excluded from the study. Of the 137 remaining patients, 51 (37%) who received anatomical resection via VATS and 38 (28%) via conversion to thoracotomy were included in the study, but 48 (35%) with planned thoracotomy were excluded. Gender, previous medical history, American Society of Anesthesiologists (ASA) score, body mass index (BMI) and forced expiratory volume for 1 second (FEV1) were not different between the two groups. However, age (P<0.01), enlarged lymph node by chest computed tomography (P=0.04), lesion fluorodeoxyglucose (FDG) uptake except main mass by positron emission tomography with computed tomography (P=0.01) (P<0.01), and tumor location (P=0.03) were significantly different between groups. Multivariate analysis showed patient age [odds ratio (OR), 1.06; P=0.04] and tumor location (OR, 2.71; P=0.03) were predicted conversion to thoracotomy. Converted patients showed a trend for longer duration of thoracic drainage, longer hospital stays and higher blood loss, but operation time (P<0.01) was the only statistically different factor between patient groups.
Conclusions: Elderly patients, in particular if their lung mass was located in the middle or lower lobe, may be likely to convert to thoracotomy during VATS anatomical resection for lung cancer. These factors can help determine surgical approach, especially when surgeons are not familiar with VATS.