This study was aimed at exploring the risk factors for thoracotomy in patients undergoing thoracoscopic resection of lung cancer and further analyzing the factors affecting the prognosis of patients. Ninety-six patients with non-small-cell lung cancer who underwent thoracoscopic pulmonary resection were recruited as the subjects, and they were enrolled into the thoracoscopic group ( n = 88 ) and the thoracotomy group ( n = 8 ) according to whether thoracotomy was performed. Univariate analysis and logistic multivariate regression were performed to analyze the risk factors for conversion to thoracotomy, and nomogram prediction model was employed to analyze the prognostic factors. The results revealed that the proportion of patients over 65 years old, with history of coronary heart disease, diabetes, and pulmonary tuberculosis, etc., in the thoracotomy group and the thoracoscopic group was significantly different ( P < 0.05 ). There were statistically significant differences in the development of interlobular cleft, pleural adhesion, tumor diameter > 3.5  cm, vascular and lymph node invasion, and tumor TNM stage between the thoracotomy group and the thoracoscopic group ( P < 0.05 ). Overall, the age of patients ≥ 65 years old, tumor diameter > 3.5  cm, hypoplasia of interlobular fissure, history of pulmonary tuberculosis, pleural adhesion, and TNM stage IIIa were all independent risk factors for thoracoscopic resection of lung cancer to thoracotomy. Cox model and nomogram prediction model analysis showed that surgery methods, tumor diameter > 3.5  cm, chemotherapy cycle < 4 , chemotherapy, and TNM stage IIIa were all independent factors influencing the prognosis of patients undergoing thoracoscopic lung cancer resection. This nomogram prediction model had high application value in patient prognosis prediction.

Objective: To explore the factors affecting the intraoperative conversion of video-assisted thoracoscopic surgery (VATS) to thoracotomy in patients with lung cancer. Methods: The clinical data of 80 patients with lung cancer in The Fourth Hospital of Hebei Medical University from May 2019 to December 2021 were retrospectively analyzed. The patients who were treated with VATS alone were included into thoracoscopy group (n= 40), and those who were intraoperatively converted from VATS to thoracotomy were included into conversion group (n= 40). The medical record data were collected, the influencing factors of intraoperative conversion from VATS to thoracotomy were analyzed, and the surgical indexes and postoperative complications were compared between the two groups. Results: Multivariate regression model showed that tumor in the upper lobe, central lung cancer, history of pulmonary tuberculosis, pleural adhesion ≥ Grade-4 and maximum tumor diameter ≥ 35 mm were risk factors for patients with lung cancer undergoing conversion from VATS to thoracotomy (p< 0.05). In the conversion group, the surgical duration and hospital stay were longer, the intraoperative bleeding volume and thoracic drainage volume were larger, and the total incidence of postoperative complications was higher than those in the thoracoscopy group (p< 0.05). Conclusion: Conversion from VATS to thoracotomy may increase the risk of complications in patients with lung cancer. Tumor in the upper lobe, central lung cancer, history of pulmonary tuberculosis, high degree of pleural adhesion and large tumor diameter are risk factors for conversion from VATS to thoracotomy. doi: https://doi.org/10.12669/pjms.39.5.7422 How to cite this: Zhang Z, Zhang Y, Zhang J, Su P. Analysis of factors affecting intraoperative conversion from thoracoscopic radical resection of lung cancer to thoracotomy and intraoperative management experience. Pak J Med Sci. 2023;39(5):---------.  doi: https://doi.org/10.12669/pjms.39.5.7422 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.