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Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy.
Eur J Cardiothorac Surg. 2009 Sep; 36(3):487-90.EJ

Abstract

OBJECTIVE

Video-assisted thoracoscopic surgery (VATS) lobectomy has been employed for the treatment of lung cancer. Many investigators have reported that the outcomes of VATS lobectomy for lung cancer are comparable to those of thoracotomy; however, several controversial issues remain. One of the critical concerns is the safety. VATS lobectomy often requires an emergency conversion to thoracotomy, for example, in the event of massive bleeding. In this study, cases in which VATS lobectomy for lung cancer was converted to thoracotomy intra-operatively (converted VATS lobectomy) were identified. The safety of the converted VATS lobectomy was evaluated.

METHODS

Between 2003 and 2007, VATS lobectomy was converted to thoracotomy in 24 out of 492 cases. Information regarding the patients' characteristics, reasons for the conversion and perioperative complications as well as the recurrence and survival data were carefully reviewed. The reasons for the conversion were classified into two groups: (1) problems related to the VATS procedure (VATS-related problems) and (2) problems not related to the VATS procedure (non-VATS-related problems).

RESULTS

Of the 24 converted cases, 19 (79%) had a history of smoking. Nine patients (38%) had a history of lung disease. Left upper lobectomy was the most frequently associated with conversion (11/24, 46%), followed by right lower lobectomy and right upper lobectomy. The most frequent reasons for the conversion were hilar lymphadenopathy and bleeding (seven patients each), followed by fused fissure. Eight of the conversions were considered to be attributable to VATS-related problems. Perioperative complications were observed in four patients, consisting of prolonged air leak in three patients and transient recurrent laryngeal nerve palsy in one patient. However, there were no life-threatening complications. The median follow-up period was 26 months. Recurrence occurred in two patients: pleural dissemination in one and bone metastasis in the other. Two deaths were observed during the follow-up period: one related to lung cancer and another related to other type of cancer.

CONCLUSIONS

The safety of the conversion was acceptable. Our findings suggest that VATS lobectomy for lung cancer is feasible from the viewpoint of safety, even after taking into account the potential need for conversion to thoracotomy in some patients.

Authors+Show Affiliations

Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan. ssawada@shikoku-cc.go.jpNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

19502073

Citation

Sawada, Shigeki, et al. "Evaluation of Video-assisted Thoracoscopic Surgery Lobectomy Requiring Emergency Conversion to Thoracotomy." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 36, no. 3, 2009, pp. 487-90.
Sawada S, Komori E, Yamashita M. Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. Eur J Cardiothorac Surg. 2009;36(3):487-90.
Sawada, S., Komori, E., & Yamashita, M. (2009). Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 36(3), 487-90. https://doi.org/10.1016/j.ejcts.2009.04.004
Sawada S, Komori E, Yamashita M. Evaluation of Video-assisted Thoracoscopic Surgery Lobectomy Requiring Emergency Conversion to Thoracotomy. Eur J Cardiothorac Surg. 2009;36(3):487-90. PubMed PMID: 19502073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. AU - Sawada,Shigeki, AU - Komori,Eisaku, AU - Yamashita,Motohiro, Y1 - 2009/06/06/ PY - 2008/10/26/received PY - 2009/03/27/revised PY - 2009/04/06/accepted PY - 2009/6/9/entrez PY - 2009/6/9/pubmed PY - 2010/2/27/medline SP - 487 EP - 90 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 36 IS - 3 N2 - OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) lobectomy has been employed for the treatment of lung cancer. Many investigators have reported that the outcomes of VATS lobectomy for lung cancer are comparable to those of thoracotomy; however, several controversial issues remain. One of the critical concerns is the safety. VATS lobectomy often requires an emergency conversion to thoracotomy, for example, in the event of massive bleeding. In this study, cases in which VATS lobectomy for lung cancer was converted to thoracotomy intra-operatively (converted VATS lobectomy) were identified. The safety of the converted VATS lobectomy was evaluated. METHODS: Between 2003 and 2007, VATS lobectomy was converted to thoracotomy in 24 out of 492 cases. Information regarding the patients' characteristics, reasons for the conversion and perioperative complications as well as the recurrence and survival data were carefully reviewed. The reasons for the conversion were classified into two groups: (1) problems related to the VATS procedure (VATS-related problems) and (2) problems not related to the VATS procedure (non-VATS-related problems). RESULTS: Of the 24 converted cases, 19 (79%) had a history of smoking. Nine patients (38%) had a history of lung disease. Left upper lobectomy was the most frequently associated with conversion (11/24, 46%), followed by right lower lobectomy and right upper lobectomy. The most frequent reasons for the conversion were hilar lymphadenopathy and bleeding (seven patients each), followed by fused fissure. Eight of the conversions were considered to be attributable to VATS-related problems. Perioperative complications were observed in four patients, consisting of prolonged air leak in three patients and transient recurrent laryngeal nerve palsy in one patient. However, there were no life-threatening complications. The median follow-up period was 26 months. Recurrence occurred in two patients: pleural dissemination in one and bone metastasis in the other. Two deaths were observed during the follow-up period: one related to lung cancer and another related to other type of cancer. CONCLUSIONS: The safety of the conversion was acceptable. Our findings suggest that VATS lobectomy for lung cancer is feasible from the viewpoint of safety, even after taking into account the potential need for conversion to thoracotomy in some patients. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/19502073/Evaluation_of_video_assisted_thoracoscopic_surgery_lobectomy_requiring_emergency_conversion_to_thoracotomy_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2009.04.004 DB - PRIME DP - Unbound Medicine ER -