Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy
Herrera, Luis J. Schumacher, Lana Y. Hartwig, Matthew G. Bakhos, Charles T. Reddy, Rishindra M. Vallières, Eric Kent, Michael S.
Herrera, Luis J.
Schumacher, Lana Y.
Hartwig, Matthew G.
Bakhos, Charles T.
Reddy, Rishindra M.
Vallières, Eric
Kent, Michael S.
Citations
Altmetric:
Genre
Journal article
Date
2023-06-13
Advisor
Committee member
Group
Department
Thoracic Medicine and Surgery
Permanent link to this record
Collections
Research Projects
Organizational Units
Journal Issue
DOI
http://dx.doi.org/10.1016/j.jtcvs.2022.10.050
Abstract
Objective: Conversion to thoracotomy continues to be a concern during minimally invasive lobectomy. The aim of this propensity-matched cohort study is to analyze the outcomes and risk factors of intraoperative conversion during video-assisted thoracoscopic surgery (VATS) and robotic lobectomy (RL). Methods: Data from consecutive lobectomy cases performed for clinical stage IA to IIIA lung cancer was retrospectively collected from the Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study consortium of 21 institutions from 2011 to 2019. The propensity-score method of inverse-probability of treatment weighting was used to balance the baseline characteristics across surgical approaches. Univariate logistic regression models were applied to test risk factors for conversion. Multivariable logistic regression analysis was conducted using a stepwise model selection method. Results: Seven thousand two hundred sixteen patients undergoing lobectomy were identified: RL (n = 2968), VATS (n = 2831), and open lobectomy (n = 1417). RL had lower conversion rate compared with VATS (3.6% vs 12.9%; P < .0001). In the multivariable regression model, tumor size and neoadjuvant therapy were the most significant risk factors for conversion, followed by prior cardiac surgery, congestive heart failure, chronic obstructive pulmonary disease, VATS approach, male gender, body mass index, and forced expiratory volume in 1 minute. Conversions for anatomical reasons were more common in VATS than RL (66.6% vs 45.6%; P = .0002); however, conversions for vascular reasons were more common in RL than VATS (24.8% vs 14%; P = .01). The rate of emergency conversions was comparable between RL and VATS (0.5% vs 0.7%; P = .25) with no intraoperative mortalities. Conclusions: Converted minimally invasive lobectomies were not associated with worse perioperative mortality compared with open lobectomy. Compared with VATS lobectomy, RL is associated with a lower probability of conversion in this propensity-score matched cohort study.
Description
Citation
Luis J. Herrera, Lana Y. Schumacher, Matthew G. Hartwig, Charles T. Bakhos, Rishindra M. Reddy, Eric Vallières, Michael S. Kent, Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy, The Journal of Thoracic and Cardiovascular Surgery, Volume 166, Issue 1, 2023, Pages 251-262.e3, ISSN 0022-5223, https://doi.org/10.1016/j.jtcvs.2022.10.050.
Citation to related work
Elsevier
Has part
The Journal of Thoracic and Cardiovascular Surgery (JTCVS), Vol. 166, Iss. 1
ADA compliance
For Americans with Disabilities Act (ADA) accommodation, including help with reading this content, please contact scholarshare@temple.edu