Conversion due to vascular injury during video-assisted thoracic surgery lobectomy: A multicentre retrospective analysis from the Italian video-assisted thoracic surgery group registry

Abstract

Objectives: Vascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. Methods: The Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. Results: Ten institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. Conclusion: Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons' seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.

Prognostic Factors of Complications After Thoracoscopic Lobectomy for Non-Small Cell Lung Cancer-A Retrospective Study

“…Respiratory complications were more common in the conversion group (p = 0.012), but accidental thoracotomy did not increase the overall surgical morbidity and mortality [40]. A multi-center retrospective analysis in Italy showed that unplanned thoracotomy was signi cantly associated with postoperative morbidity [15]. Among Bertolaccini L's research, intraoperative vascular injury, pleural adhesions, age > 60 years and resection locations were all factors that affect the incidence of PCCs and mortality.…”

“…Among Bertolaccini L's research, intraoperative vascular injury, pleural adhesions, age > 60 years and resection locations were all factors that affect the incidence of PCCs and mortality. Experience was an independent factor to predict conversion [15]. However, studies of the same type put forward different points of view.…”

“…Some studies found that elderly patients were more likely to have PCCs [14,15], but a prospective American research suggested that age could not predict the occurrence of major postoperative complications [16], and one patient's physique-related indexes could better predict the occurrence of PCCs. The Charlson Comorbidity Index (CCI) is also a good indicator for evaluating postoperative complications [15,17], and CCI has many overlaps with the criteria for assessing frailty, so both can re ect frailty. In addition, it is still controversial whether intraoperative conversion to thoracotomy and LSHS before surgery can be used as risk factors for PCCs.…”

A novel guiding tube modified from a Foley catheter for endostapling during robot-assisted pulmonary resection

“…invasive pulmonary resection (4). Once the main vessel is injured during operation, conversion to thoracotomy is an unavoidable consequence in some scenarios (8,10,15,16).…”

International expert consensus on the management of bleeding during VATS lung surgery

“…Among these cases, 88 (3%) patients suffered from intraoperative bleeding due to vascular injury, and 70 (79.5%) cases were converted to open surgery (34). A recent study of the Italian VATS lobectomy registry enrolled 1,679 cases from ten high-volume centers found that the bleeding-related conversion rate was 2.6% among all the patients (37). Massive bleeding from vascular injury prolongs hospital stay and increases hospitalization costs significantly (30).…”