Worse outcomes after conversion of thoracoscopic lobectomy for lung cancer

OBJECTIVES: Conversion of thoracoscopic lobectomy for lung cancer to thoracotomy can adversely affect short-term outcomes, but the impact on long-term outcomes is unknown. This study aimed to identify the risk factors for conversion and to determine the influence of conversion on the outcomes of lung cancer treatment. METHODS: This retrospective study included 1002 consecutive patients with lung cancer who underwent thoracoscopic lobectomy between 7 June 1999 and 17 July 2018. The groups of patients with and without conversion were compared in terms of possible risk factors and the short- and long-term outcomes. The survival of patients was analysed by the Kaplan-Meier method. RESULTS: Conversion was done in 105 patients (10.5%). On multivariable logistic regression analysis, the independent risk factors for conversion were pleural adhesions (P<0.001) and mediastinal lymph node metastases (P<0.001). Compared with the non-conversion group, the conversion group had longer chest drainage time (4 vs 3days, P<0.001) and hospital stay (8 vs 6days, P<0.001); more frequent complications (38.1% vs 27.1%, P=0.018), including red blood cell transfusion (10.5% vs 2%, P<0.001) and supraventricular arrhythmia (13.3% vs 7.5%, P=0.037); and lower 5-year survival rate in patients with stage I lung cancer (70% vs 87%, P=0.014). Conversion did not increase in-hospital mortality. CONCLUSIONS: Pleural adhesions and lymph node metastases increased the probability of conversion to thoracotomy. Conversion adversely affected the short-term outcomes of thoracoscopic lobectomy. Long-term outcomes of treatment of non-small-cell lung cancer could be worse in patients after conversion, but definitive conclusions cannot be made in this regard because of the absence of control of selection bias.