Background Lung cancer resections are increasingly being performed via video-assisted thoracoscopic surgery (VATS). Conversion to thoracotomy can occur for many reasons and may affect outcomes. The objective of this study was to investigate the impact of VATS conversion on short- and mid-term outcomes and identify reasons for conversion. Methods Consecutive patients undergoing lobectomy for primary non-small cell lung cancer between 2012 and 2019 in a single UK center were included. Primary outcomes were 90-day mortality, intraoperative conversion, and overall survival. Reasons for conversion were defined as bleeding or nonbleeding. Outcomes were compared between groups using univariable analysis. Multivariable logistic regression analysis was performed to identify risk factors for conversion. Results A total of 2,622 patients were included with 20.6% (n = 541) completing surgery via VATS and 79.4% (n = 2,081) via thoracotomy. The rate of completed VATS surgery increased significantly over time (2012: 6.9%, 2019: 55.1%, p < 0.001). Overall conversion rate was 14.3% (n = 90/631) and has reduced significantly over time (p < 0.001). The rate of conversion due to intraoperative bleeding was 31.1% (n = 28/90). Obesity, male sex, and stage III disease were independent risk factors for conversion. The 90-day mortality rate after conversion was not significantly different from the rate for planned thoracotomy (3.3 vs. 3.4%, p = 0.987). There was no significant difference in overall survival between patients experiencing intraoperative conversion and those undergoing planned thoracotomy (p = 0.135). Conclusion This study demonstrates comparable outcomes for patients undergoing conversion from VATS to those undergoing planned surgery via thoracotomy. It remains unclear if reason for conversion is associated with outcomes.

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视频辅助胸腔镜肺叶切除术转换为开胸手术后的结果

背景 肺癌切除术越来越多地通过电视胸腔镜手术（VATS）进行。转开胸手术的原因有很多，并且可能会影响结果。本研究的目的是调查 VATS 转换对短期和中期结果的影响，并确定转换的原因。方法 纳入 2012 年至 2019 年在英国单个中心连续接受原发性非小细胞肺癌肺叶切除术的患者。主要结局是 90 天死亡率、术中转化和总生存率。转化的原因被定义为出血或非出血。使用单变量分析比较组间的结果。进行多变量逻辑回归分析以确定转换的风险因素。结果 共有 2,622 名患者参与其中，其中 20.6%（n = 541）通过 VATS 完成手术，79.4%（n = 2,081）通过开胸手术完成手术。随着时间的推移，VATS 手术的完成率显着增加（2012 年：6.9%，2019 年：55.1%，p < 0.001）。总体转化率为 14.3% (n = 90/631)，并且随着时间的推移显着降低 (p < 0.001)。术中出血导致的中转率为 31.1% (n = 28/90)。肥胖、男性和 III 期疾病是转化的独立危险因素。转换后的 90 天死亡率与计划开胸手术的死亡率没有显着差异（3.3% vs. 3.4%，p = 0.987）。经历术中转换的患者和接受计划开胸手术的患者之间的总生存率没有显着差异（p = 0.135）。结论 本研究表明，接受 VATS 转换的患者与接受计划开胸手术的患者的结果相当。目前尚不清楚转换的原因是否与结果相关。