Pulmonary Open, Robotic and Thoracoscopic Lobectomy (PORTaL) Study: Outcomes and risk factors of conversion during minimally invasive lobectomy
2022-11-25 16:48:41
SCI 24 November 2022
Pulmonary Open, Robotic and Thoracoscopic Lobectomy (PORTaL) Study: Outcomes and risk factors of conversion during minimally invasive lobectomy
(The Journal of Thoracic and Cardiovascular Surgery, IF: 6.439)
Luis J. Herrera, MD, Lana Y. Schumacher, MD, Matthew G. Hartwig, MD, Charles T. Bakhos, MD, Rishindra M. Reddy, MD, MBA, Eric Vallières, MD, Michael S. Kent, MD
CORRESPONDENCE TO: Luis J Herrera MD, Orlando Health Cancer Institute, 1400 South Orange Avenue, MP-760, 50 Orlando Florida 32806
Objective
Conversion to thoracotomy continues to be a concern during minimally invasive lobectomy. The aim of this propensity matched study is to analyze the outcomes and risk factors of intraoperative conversion during thoracoscopic (VATS) and robotic lobectomy (RL).
Methods
Data from consecutive lobectomy cases performed for clinical stage IA-IIIA lung cancer was retrospectively collected from the PORTaL consortium of 21 institutions from 2011-2019. The propensity-score method of inverse-probability of treatment weighting (IPTW) 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
7,216 patients undergoing lobectomy were identified: RL (n=2968), VATS (n=2831) and open lobectomy (n=1417). RL had lower conversion rate compared to VATS (3.6% vs 12.9%; p<0.0001). In the multivariable regression model, tumor size and neo-adjuvant therapy were the most significant risk factors for conversion, followed by prior cardiac surgery, CHF, COPD, VATS approach, male gender, BMI, and FEV-1 (Figure-1). Conversions for anatomical reasons were more common in VATS than RL (66.6% vs 45.6%, p=0.0002); however, conversions for vascular reasons were more common in RL than VATS (24.8% vs 14%, p=0.01). The rate of emergent conversions was comparable between RL and VATS (0.5% vs 0.7%, p=0.25) with no intraoperative mortalities.
Conclusions
Converted minimally invasive lobectomies were not associated with worse perioperative mortality compared to open lobectomy. Compared to VATS lobectomy, RL is associated with a lower probability of conversion in this propensity matched study.
