Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections: an intention-to-treat analysis

Decaluwé, Herbert; Petersen, René Horsleben; Hansen, Henrik Jessen; Piwkowski, Cezary; Augustin, Florian; Brunelli, Alessandro; Schmid, Thomas; Papagiannopoulos, Kostas; Moons, Johnny; Gossot, Dominique

doi:10.1093/ejcts/ezv287

Cited by 116 publications

(109 citation statements)

References 22 publications

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“…10,17 The incidence of conversion due to intraoperative bleeding is reported as ranging from less than 1% to 5%, 3,11,12 which is in line with the results of our series. Although uncommon, catastrophic bleeding encountered during VATS is associated with poor postoperative outcomes 8 and is thought to be underreported in the literature. 17 Despite the expanding patient cohort undergoing VATS lobectomy in our unit, our results demonstrate that the incidence of intraoperative major bleeding necessitating conversion has remained low.…”

Section: Discussionmentioning

confidence: 99%

“…6 Despite this, the use of thoracoscopic lobectomy remains variable and it comprised less than 25% of all lobectomy procedures performed for NSCLC in Europe in 2013. [7][8][9] Concerns regarding the impact of intraoperative complications and subsequent conversion have hindered the widespread implementation of VATS lobectomy. The reported incidence of unplanned conversion to thoracotomy ranges from less than 5% to over 20%.…”

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confidence: 99%

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The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

Vallance

Tcherveniakov

Bogdan

et al. 2017

annals

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INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010-2012: 277/713 [38.8%], 2013-2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

Vallance

Tcherveniakov

Bogdan

et al. 2017

annals

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“…There was 1 intraoperative death whose case has been reported (13). In the remaining 234 surgical procedures median operation time was 150 min (range, 50−332 min).…”

Section: Review Article On Thoracic Surgerymentioning

confidence: 99%

Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

et al. 2016

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Although the interest for thoracoscopic sublobar resections (TSLR) is rising, its use for treating non-small cell lung carcinoma (NSCLC) is still controversial because publications dealing with survival and recurrence rate provide contradictory results. If applied to the resection of lung cancer, thoracoscopic segmentectomies must be performed according to oncological criteria. The aim of this technical paper is to give some technical details on thoracoscopic segmentectomies for the treatment of malignancies.Our experience is based on 235 thoracoscopic anatomical segmentectomies performed in 232 patients for a malignant lesion between January 2007 and July 2016. Indication for segmentectomy was a proven or suspected NSCLC in 184 and suspected metastasis in 51 patients. Intraoperative and postoperative data were recorded in a prospective manner. There were eight conversions into a posterolateral thoracotomy (3.4%) and seven unplanned additional pulmonary resections for an oncological reason (3%). We discuss some technical refinements that could minimize these adverse events and make thoracoscopic segmentectomy a safe and reliable procedure.

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“…However, despite its benefits, VATS lobectomy is generally considered to be technically more difficult compared to lobectomy by thoracotomy and inexperience may be cause of intraoperative complications and eventually mortality (8). Probably, this is one of the reasons why a formal and structured VATS lobectomy program is strongly felt among thoracic surgery trainees during their training years.…”

Section: Introductionmentioning

confidence: 99%

VATS lobectomy program: the trainee perspective

et al. 2016

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Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections: an intention-to-treat analysis

Abstract: Major intraoperative complications during VATS anatomical lung resections are infrequent, seem not to be related to surgical experience but have an important impact on patient outcome. Constant awareness and a structured plan of action are of paramount importance to prevent them.

Cited by 116 publications

References 22 publications

The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

VATS lobectomy program: the trainee perspective

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