Maurizio V Infante1, Cristiano Benato1, Ronaldo Silva2, Gaetano Rocco3, Alessandro Bertani4, Luca Bertolaccini5, Alessandro Gonfiotti6, Riccardo Giovannetti1, Cinzia Bonadiman1, Alessandro Lonardoni1, Barbara Canneto1, Giovanni Falezza1, Paola Gandini1, Carlo Curcio7, Roberto Crisci8. 1. Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy. 2. Clinical Research Unit, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy. 3. Thoracic Surgery Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Division of Thoracic Surgery and Lung Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy. 5. Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy. 6. Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy. 7. Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy. 8. Department of Thoracic Surgery, University Hospital "Mazzini", Teramo, Italy.
Abstract
OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.
OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.
Authors: Dariusz A Dziedzic; Marcin Zbytniewski; Grzegorz M Gryszko; Marcin M Cackowski; Renata Langfort; Tadeusz M Orlowski Journal: J Thorac Dis Date: 2021-01 Impact factor: 2.895
Authors: Jia Huang; Yu Tian; Qian-Jun Zhou; Jun-Wei Ning; Ze-Nan Gu; Pei-Ji Lu; Jian-Tao Li; Hao Lin; Tian-Xiang Chen; Yun-Hai Yang; Min P Kim; Robert E Merritt; Marco Ghisalberti; Long Jiang; Qing-Quan Luo Journal: Transl Lung Cancer Res Date: 2021-12