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Herrera LJ, Schumacher LY, Hartwig MG, Bakhos CT, Reddy RM, Vallières E, Kent MS. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01236-3. [PMID: 36509569 DOI: 10.1016/j.jtcvs.2022.10.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Luis J Herrera
- Division of Thoracic Surgery, Orlando Health, Orlando, Fla.
| | - Lana Y Schumacher
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | | | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - Rishindra M Reddy
- Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Mich
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash
| | - Michael S Kent
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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Perez Holguin RA, Stahl KA, Hendriksen BS, Wong WG, Olecki EJ, Vining CC, Dixon ME, Peng JS, Shen C. Predictors of Conversion During Minimally Invasive Gastrectomy for Malignancy. J Surg Res 2022; 279:275-284. [PMID: 35802942 DOI: 10.1016/j.jss.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Implementation of minimally invasive gastrectomy (MIG) for malignancy is increasing. However, risk factors for conversion to open surgery during laparoscopic and robotic gastrectomy are poorly understood. This study aimed to determine the risk factors for, and impact of, conversion during oncologic resection. METHODS The National Cancer Database (NCDB) was used to identify patients with clinical stage I-III gastric cancer from 2010 to 2017. Chi-squared test and t-test were used to compare the robotic versus laparoscopic groups. Propensity score weighted multivariable logistic regression was used to evaluate factors associated with conversion to open surgery. RESULTS Of 6990 patients identified, 5702 (81.6%) underwent a laparoscopic resection and 1288 (18.4%) underwent robotic-assisted resection. Conversion rates were 14.7% and 7.8% for laparoscopic and robotic gastrectomy, respectively. The robotic approach was associated with lower likelihood of conversion compared to laparoscopic approach (odds ratio [OR] = 0.470, P < 0.001). Other factors predictive of conversion included tumor size >5 cm compared to <2 cm (OR 1.714, P = 0.010), total gastrectomy compared to partial gastrectomy (OR 2.019, P < 0.001), antrum/pylorus (OR 2.345, P < 0.001), and body (OR 2.152, P < 0.001) tumors compared to cardia tumors. Compared to those treated with laparoscopic and robotic gastrectomy, patients who underwent conversion experienced significantly longer hospital length of stay and higher rates of positive surgical margins. CONCLUSIONS Laparoscopic gastrectomy was associated with a higher conversion rate compared to robotic gastrectomy. Conversion to open surgery was associated with a significantly longer length of stay and higher rates of positive margins. Identification of risk factors for conversion can aid in appropriate modality selection.
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Affiliation(s)
- Rolfy A Perez Holguin
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Kelly A Stahl
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Brandon S Hendriksen
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - William G Wong
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Elizabeth J Olecki
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Charles C Vining
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Matthew E Dixon
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - June S Peng
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
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Muslim Z, Stroever S, Poulikidis K, Weber JF, Connery CP, Herrera LJ, Bhora FY. Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:148-155. [DOI: 10.1177/15569845221091979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to identify predictors of conversion to thoracotomy and test the hypothesis that conversion is associated with inferior perioperative outcomes in non-small cell lung cancer (NSCLC). Methods: We queried the National Cancer Database for patients with stage I to III NSCLC undergoing minimally invasive surgery (MIS) during 2010 to 2016. We compared clinicopathologic factors between patients undergoing MIS with and without conversion. We fitted multivariable regression models to identify independent predictors of conversion and compare perioperative outcomes between the 2 groups. Results: A rising trend in the use of MIS was accompanied by a declining trend in the rate of conversion to thoracotomy. A total of 11.3% of the 83,219 cases were converted. Conversion was associated with a higher Charlson-Deyo score, squamous histology, nodal involvement, high tumor grade, tumor size ≥5 cm, and a higher T stage ( P < 0.05). Successful MIS without conversion was predicted by advanced age, sublobar resection, robotic approach, and treatment at an academic high-volume facility ( P < 0.05). Conversion was linked to longer hospital stays, higher 30-day and 90-day mortality, and unplanned readmission ( P < 0.05), irrespective of the type of MIS approach. Conclusions: Conversion rates for video-assisted and robot-assisted thoracoscopic surgery have seen a decline in recent years. Irrespective of the type of MIS approach, conversion was associated with inferior perioperative outcomes. The robotic approach and treatment at an academic high-volume facility were associated with a lower likelihood of conversion. Early recognition of the individual risk factors for conversion may help to counsel patients about the likelihood of, and detriments associated with, conversion and ultimately reduce conversion rates.
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Affiliation(s)
- Zaid Muslim
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
| | | | - Kostantinos Poulikidis
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
- Division of Thoracic Surgery, Nuvance Health, Danbury, CT, USA
| | - Joanna F. Weber
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
| | - Cliff P. Connery
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, NY, USA
| | - Luis J. Herrera
- Thoracic Surgery Section, Orlando Health, University of Florida, Gainesville, FL, USA
| | - Faiz Y. Bhora
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
- Division of Thoracic Surgery, Nuvance Health, Danbury, CT, USA
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, NY, USA
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Patel YS, Hanna WC, Fahim C, Shargall Y, Waddell TK, Yasufuku K, Machuca TN, Pipkin M, Baste JM, Xie F, Shiwcharan A, Foster G, Thabane L. RAVAL trial: Protocol of an international, multi-centered, blinded, randomized controlled trial comparing robotic-assisted versus video-assisted lobectomy for early-stage lung cancer. PLoS One 2022; 17:e0261767. [PMID: 35108265 PMCID: PMC8809527 DOI: 10.1371/journal.pone.0261767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background Retrospective data demonstrates that robotic-assisted thoracoscopic surgery provides many benefits, such as decreased postoperative pain, lower mortality, shorter length of stay, shorter chest tube duration, and reductions in the incidence of common postoperative pulmonary complications, when compared to video-assisted thoracoscopic surgery. Despite the potential benefits of robotic surgery, there are two major barriers against its widespread adoption in thoracic surgery: lack of high-quality prospective data, and the perceived higher cost of it. Therefore, in the face of these barriers, a prospective randomized controlled trial comparing robotic- to video-assisted thoracoscopic surgery is needed. The RAVAL trial is a two-phase, international, multi-centered, blinded, parallel, randomized controlled trial that is comparing robotic- to video-assisted lobectomy for early-stage non-small cell lung cancer that has been enrolling patients since 2016. Methods The RAVAL trial will be conducted in two phases: Phase A will enroll 186 early-stage non-small cell lung cancer patients who are candidates for minimally invasive pulmonary lobectomy; while Phase B will continue to recruit until 592 patients are enrolled. After consent, participants will be randomized in a 1:1 ratio to either robotic- or video-assisted lobectomy, and blinded to the type of surgery they are allocated to. Health-related quality of life questionnaires will be administered at baseline, postoperative day 1, weeks 3, 7, 12, months 6, 12, 18, 24, and years 3, 4, 5. The primary objective of the RAVAL trial is to determine the difference in patient-reported health-related quality of life outcomes between the robotic- and video-assisted lobectomy groups at 12 weeks. Secondary objectives include determining the differences in cost-effectiveness, and in the 5-year survival data between the two arms. The results of the primary objective will be reported once Phase A has completed accrual and the 12-month follow-ups are completed. The results of the secondary objectives will be reported once Phase B has completed accrual and the 5-year follow-ups are completed. Discussion If successfully completed, the RAVAL Trial will have studied patient-reported outcomes, cost-effectiveness, and survival of robotic- versus video-assisted lobectomy in a prospective, randomized, blinded fashion in an international setting. Trial registration ClinicalTrials.gov, NCT02617186. Registered 22-September-2015. https://clinicaltrials.gov/ct2/show/NCT02617186
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Affiliation(s)
- Yogita S. Patel
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Waël C. Hanna
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christine Fahim
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tiago N. Machuca
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Mauricio Pipkin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Jean-Marc Baste
- Division of Thoracic Surgery, Department of Surgery, Rouen Normandy University, Rouen Cedex, France
| | - Feng Xie
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Shiwcharan
- Funding Reform and Case Costing, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Seder CW, Farrokhyar F, Nayak R, Baste JM, Patel Y, Agzarian J, Finley CJ, Shargall Y, Thomas PA, Dahan M, Verhoye JP, Mbadinga F, Hanna WC. Robotic vs. Thoracoscopic Anatomic Lung Resection in Obese Patients: A Propensity Adjusted Analysis. Ann Thorac Surg 2021; 114:1879-1885. [PMID: 34742733 DOI: 10.1016/j.athoracsur.2021.09.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Minimally-invasive lung resections can be particularly challenging in obese patients. We hypothesized robotic surgery (RTS) is associated with less conversion to thoracotomy than thoracoscopic surgery (VATS) in obese populations. METHODS The STS GTSD, Epithor French National Database, and McMaster University Database were queried for obese (BMI≥30 kg/m2) patients who underwent VATS or RTS lobectomy or segmentectomy for clinical T1-2, N0-1 NSCLC between 2015-2019. Propensity score adjusted logistic regression analysis was used to compare the rate of conversion to thoracotomy between the VATS and RTS cohorts. RESULTS Overall, 8,108 patients (STS GTSD: n=7,473; Epithor: n=572; McMaster: n=63) met inclusion criteria with a mean age of 66.6 years (SD 9 years) and BMI of 34.7 kg/m2 (SD 4.5 kg/m2). After propensity score adjusted multivariable analysis, patients who underwent VATS were over 5 times more likely to experience conversion to thoracotomy than those who underwent RTS (OR=5.33; 95% CI 4.14, 6.81, p<0.001). There was a linear association between degree of obesity and odds ratio of VATS conversion to thoracotomy compared to RTS. The VATS cohort had a longer mean length of stay (5.0 vs. 4.3 days, p<0.001), higher rate of respiratory failure (2.8% [168/5975] vs. 1.8% [39/2133], p=0.026), and were less likely to be discharged to their home (92.5% [5,525/5,975] vs. 94.3% [2,012/2,133]; p=0.013) compared to RTS patients. CONCLUSIONS In obese patients, RTS anatomic lung resection is associated with a lower rate of conversion to thoracotomy than VATS.
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Affiliation(s)
- Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Forough Farrokhyar
- The Office of Surgical Research Services, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rahul Nayak
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jean-Marc Baste
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Yogita Patel
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Pascal-Alexandre Thomas
- Departement de Chirurgie Thoracique, Hopitaux Universitaires de Marseille, Marseille, France
| | - Marcel Dahan
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Philippe Verhoye
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frankie Mbadinga
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
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Power AD, Merritt RE, Abdel-Rasoul M, Moffatt-Bruce SD, D'Souza DM, Kneuertz PJ. Estimating the risk of conversion from video-assisted thoracoscopic lung surgery to thoracotomy-a systematic review and meta-analysis. J Thorac Dis 2021; 13:812-823. [PMID: 33717554 PMCID: PMC7947549 DOI: 10.21037/jtd-20-2950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Understanding the risk of conversion from video-assisted thoracic surgery (VATS) to thoracotomy is important when considering patient selection and preoperative surgical risk assessment. This review aims to estimate the rate of intraoperative conversions to thoracotomy, predictive factors, and associated outcomes for VATS anatomic lung resections. Methods PubMed/MEDLINE and EMBASE were searched systematically in May of 2020. Observational studies examining conversions of VATS anatomic resections to thoracotomy were included. Conversion rates, causes, risk factors, and post-operative outcomes were reviewed and analyzed in aggregate. Results Twenty retrospective studies were reviewed, with a total of 72,932 patients undergoing VATS anatomic lung resection. The median conversion rate was 9.6% (95% CI: 6.6–13.9%). Nine studies reported a total of 114 emergency conversions, with a median incidence rate of 1.3% (95% CI: 0.6–2.8%). The most common reasons for thoracotomy were vascular injury/bleeding, difficulty lymph node dissection, and adhesions, accounting for 27.9%, 26.2% and 19% of conversions, respectively. Risk factors for conversion varied, but frequently included nodal disease, large tumors, and induction therapy. The risk of complications (OR 2.06; 95% CI: 1.77–2.40) and mortality (OR 4.11; 95% CI: 1.59–10.61) were significantly increased following conversions. There was also a significant increase in chest tube duration and length of stay following conversion. Conclusions The risk of conversion to thoracotomy may be as high as one in ten patients undergoing VATS anatomic lung resections, but may vary significantly based on patient selection. Although emergent conversions are rare, the need for thoracotomy may significantly increase postoperative morbidity and mortality.
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Affiliation(s)
- Alexandra D Power
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert E Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susan D Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Chen D, Kang P, Tao S, Wu L, Li Q, Tan Q. Risk factors of conversion in robotic- and video-assisted pulmonary surgery for non-small cell lung cancer. Updates Surg 2021; 73:1549-1558. [PMID: 33398772 DOI: 10.1007/s13304-020-00954-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to investigate risk factors of conversion to thoracotomy for patients with non-small cell lung cancer (NSCLC) underwent robotic- (RATS) or video-assisted thoracoscopic surgery (VATS). METHODS A retrospective review was conducted to included consecutive participants from January 2016 to December 2018. Three groups [mini-invasive, conversion, and up-front open thoracotomy (OT) groups] and two series of comparison (conversion versus mini-invasive, and conversion versus OT) were generated. Propensity score-matched analysis (1:1) was conducted to verify outcomes of complications and perioperative factors. Multivariate binary logistic regression analysis was used to identify potential risk factors of conversion. RESULTS 1177 patients (912 in mini-invasive group, 180 in conversion group, and 85 in OT group) were included. The overall conversion rate was 16.5%. Robotic approach resulted in dramatically lower conversion rate compared to VATS (2.4% vs 25.1%, p < 0.001). After propensity adjustment, no significant difference of complication rates was identified when comparing conversion group with mini-invasive and OT groups. Multivariate regression analyses shown that robotic approach (odd ratio (OR) = 0.037, 95% confidential interval (CI) 0.016-0.087), tumor size < 5 cm (OR = 0.274, 95% CI 0.152-0.493), no chief symptom(OR = 0.311, 95% CI 0.178-0.545), body mass index < 25 kg/m2 (OR = 0.537, 95% CI 0.343-0.842), and lobectomy (OR = 0.079, 95% CI 0.017-0.370) were independent protectors of conversion. CONCLUSIONS Seven demographic factors might be recognized as independent predictors of conversion. For patients with highly risk of conversion, robotic approach is recommended to perform mini-invasive pulmonary surgery over VATS.
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Affiliation(s)
- Dali Chen
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, 10# Changjiang Zhilu Daping, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Poming Kang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, 10# Changjiang Zhilu Daping, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Shaolin Tao
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, 10# Changjiang Zhilu Daping, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Licheng Wu
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, 10# Changjiang Zhilu Daping, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Qingyuan Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, 10# Changjiang Zhilu Daping, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, 10# Changjiang Zhilu Daping, Yuzhong District, Chongqing, 400042, People's Republic of China.
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Outcomes After Converted Minimally Invasive to Open Esophagectomy in Patients With Esophageal Cancer. Ann Thorac Surg 2020; 112:1593-1599. [PMID: 33333084 DOI: 10.1016/j.athoracsur.2020.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the impact of unplanned conversion to open esophagectomy during minimally invasive esophagectomy (MIE) on postoperative morbidity and mortality for patients with esophageal cancer, as well as to evaluate the variables that influence the need for conversion. METHODS This study was a retrospective analysis of patients with esophageal cancer who underwent open esophagectomy or MIE by either a laparothoracoscopic approach or a robotic approach from 2016 to 2018 by using the esophagectomy-specific American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Poisson regression models were used to analyze 30-day outcomes and risk factors for conversion to open esophagectomy during attempted MIE. RESULTS A total of 2616 patients were identified. The overall conversion rate for MIE was 6.3%. Compared with completed MIE, patients requiring conversion to open esophagectomy had a significantly increased risk of 30-day mortality (risk ratio, 2.63; 95% confidence interval, 1.03 to 6.69) and experienced a variety of other postoperative complications. Patients requiring conversion to open esophagectomy during MIE also experienced worse perioperative outcomes when compared to patients who underwent planned open esophagectomy. Estimated surgical risk on the basis of the ACS NSQIP Surgical Risk Calculator was the only variable found to be independently associated with conversion from minimally invasive to open esophagectomy (risk ratio, 1.03; 95% confidence interval, 1.01 to 1.04, for each 10% increase in risk score). CONCLUSIONS Unplanned conversion to open esophagectomy during MIE is associated with significantly greater morbidity and a 2.6-fold increased risk of death when compared with both completed MIE and planned open esophagectomy. The ACS NSQIP Surgical Risk Calculator may help identify patients preoperatively who are at higher risk for conversion to open esophagectomy during MIE.
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Nurse staffing and outcomes for pulmonary lobectomy: Cost and mortality trade-offs. Heart Lung 2020; 50:206-212. [PMID: 33302148 DOI: 10.1016/j.hrtlng.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nurse staffing impacts patient outcomes, but little is known about the relationship between nurse staffing and outcomes for lung cancer patients undergoing pulmonary lobectomy. OBJECTIVES To examine the association between nurse staffing and outcomes following lobectomy for lung cancer. METHODS Patients (N = 16,994) with lung cancer between who underwent lobectomy between 2008-2011 were identified in the National Inpatient Sample. Nurse staffing was quantified using registered nurse full-time equivalents per adjusted patient days. Multivariable models were used to estimate the effect of RN FTEs on mortality, length of stay, and costs, controlling for covariates. RESULTS Patients treated at hospitals using 5.6 or more RN FTEs had shorter hospitals stays by 0.37 days (p = 0.008), had 36% lower odds of mortality (OR = 0.64, p = 0.014), but incurred $4,388 (p < 0.0001) in additional costs. CONCLUSIONS Hospital administrators face a troubling trade-off between costs and outcomes in decisions about nurse staffing mix for pulmonary lobectomy.
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