Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Development of a Risk Scoring Model to Predict Unexpected Conversion to Thoracotomy during Video-Assisted Thoracoscopic Surgery for Lung Cancer

  • Ga Young Yoo (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Seung Keun Yoon (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Mi Hyoung Moon (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Seok Whan Moon (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Wonjung Hwang (Department of Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kyung Soo Kim (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2023.10.06
  • Accepted : 2024.01.15
  • Published : 2024.05.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion: We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.

Keywords

References

  1. Klapper J, D'Amico TA. VATS versus open surgery for lung cancer resection: moving toward a minimally invasive approach. J Natl Compr Canc Netw 2015;13:162-4. https://doi.org/10.6004/jnccn.2015.0023
  2. Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer 2016;100:114-9. https://doi.org/10.1016/j.lungcan.2016.08.004
  3. Kim HK. Video-assisted thoracic surgery lobectomy. J Chest Surg 2021;54:239-45. https://doi.org/10.5090/jcs.21.061
  4. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from the Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 2008;135:247-54. https://doi.org/10.1016/j.jtcvs.2007.07.060
  5. McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 2006;81:421-5. https://doi.org/10.1016/j.athoracsur.2005.07.078
  6. Villamizar NR, Darrabie MD, Burfeind WR, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg 2009;138:419-25. https://doi.org/10.1016/j.jtcvs.2009.04.026
  7. Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008;86:2008-16. https://doi.org/10.1016/j.athoracsur.2008.07.009
  8. 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;13:812-23. https://doi.org/10.21037/jtd-20-2950
  9. Gabryel P, Piwkowski C, Kasprzyk M, Zielinski P, Roszak M, Dyszkiewicz W. Worse outcomes after conversion of thoracoscopic lobectomy for lung cancer. Interact Cardiovasc Thorac Surg 2021;32:356-63. https://doi.org/10.1093/icvts/ivaa274
  10. Park JS, Kim HK, Choi YS, Kim J, Shim YM, Kim K. Unplanned conversion to thoracotomy during video-assisted thoracic surgery lobectomy does not compromise the surgical outcome. World J Surg 2011;35:590-5. https://doi.org/10.1007/s00268-010-0913-6
  11. Matsuoka K, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Analysis of conversion to thoracotomy during thoracoscopic lung resection. Asian Cardiovasc Thorac Ann 2019;27:381-7. https://doi.org/10.1177/0218492319851396
  12. Puri V, Patel A, Majumder K, et al. Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg 2015;149:55-62. https://doi.org/10.1016/j.jtcvs.2014.08.074
  13. Byun CS, Lee S, Kim DJ, et al. Analysis of unexpected conversion to thoracotomy during thoracoscopic lobectomy in lung cancer. Ann Thorac Surg 2015;100:968-73. https://doi.org/10.1016/j.athoracsur.2015.04.032
  14. Samson P, Guitron J, Reed MF, Hanseman DJ, Starnes SL. Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg 2013;145:1512-8. https://doi.org/10.1016/j.jtcvs.2012.05.028
  15. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The eighth edition lung cancer stage classification. Chest 2017;151:193-203. https://doi.org/10.1016/j.chest.2016.10.010
  16. Noro A, Natale G, Messina G, et al. The prediction of fissure integrity by quantitative computed tomography analysis. Thorac Cardiovasc Surg 2023;71:573-81. https://doi.org/10.1055/s-0042-1755382
  17. Swanson SJ, Herndon JE, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802: a prospective, multi-institution feasibility study. J Clin Oncol 2007;25:4993-7. https://doi.org/10.1200/jco.2007.12.6649
  18. Daniels LJ, Balderson SS, Onaitis MW, D'Amico TA. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer. Ann Thorac Surg 2002;74:860-4. https://doi.org/10.1016/s0003-4975(02)03764-5
  19. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010;139:366-78. https://doi.org/10.1016/j.jtcvs.2009.08.026
  20. Stephens N, Rice D, Correa A, et al. Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-smallcell lung cancer: a propensity-matched analysis of 963 cases. Eur J Cardiothorac Surg 2014;46:607-13. https://doi.org/10.1093/ejcts/ezu036
  21. Muslim Z, Stroever S, Poulikidis K, et al. Conversion to thoracotomy in non-small cell lung cancer: risk factors and perioperative outcomes. Innovations (Phila) 2022;17:148-55. https://doi.org/10.1177/15569845221091979
  22. Smith DE, Dietrich A, Nicolas M, Da Lozzo A, Beveraggi E. Conversion during thoracoscopic lobectomy: related factors and learning curve impact. Updates Surg 2015;67:427-32. https://doi.org/10.1007/s13304-015-0334-z
  23. Roviaro G, Varoli F, Vergani C, Maciocco M, Nucca O, Pagano C. Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature. Surg Endosc 2004;18:1551-8. https://doi.org/10.1007/s00464-004-6006-6
  24. Villamizar NR, Darrabie M, Hanna J, et al. Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer. J Thorac Cardiovasc Surg 2013;145:514-20. https://doi.org/10.1016/j.jtcvs.2012.10.039
  25. Tong C, Li T, Huang C, et al. Risk factors and impact of conversion to thoracotomy from 20,565 cases of thoracoscopic lung surgery. Ann Thorac Surg 2020;109:1522-9. https://doi.org/10.1016/j.athoracsur.2019.12.009
  26. Sun W, Zhang L, Li Z, et al. Feasibility investigation of ipsilateral reoperations by thoracoscopy for major lung resection. Thorac Cardiovasc Surg 2020;68:241-5. https://doi.org/10.1055/s-0039-1683372
  27. Fabian T, Van Backer JT, Ata A. Perioperative outcomes of thoracoscopic reoperations for clinical recurrence of pulmonary malignancy. Semin Thorac Cardiovasc Surg 2021;33:230-7. https://doi.org/10.1053/j.semtcvs.2020.08.011