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
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).
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.
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.
7216例接受肺叶切除术的患者：RL（n=2968）、VATS（n=2831）和开放式肺叶切除（n=1417）。与VATS相比，RL的转化率较低（3.6%vs 12.9%；p<0.0001）。在多变量回归模型中，肿瘤大小和新辅助治疗是转换的最重要风险因素，其次是既往心脏手术、CHF、COPD、VATS方法、男性性别、BMI和FEV-1（图1）。由于解剖原因的转换在VATS中比RL更常见（66.6%对45.6%，p=0.0002）；然而，由于血管原因的转换在RL中比VATS更常见（24.8%对14%，p=0.01）。RL和VATS的急诊转换率相当（0.5%vs 0.7%，p=0.25），无术中死亡。
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.