title: Unplanned conversion to thoracotomy during video-assisted thoracic surgery lobectomy does not compromise the surgical outcome.
abstract: BACKGROUND
  Concerns remain unresolved regarding the safety of unplanned conversion to open thoracotomy during video-assisted thoracic surgery (VATS) lobectomy. We analyzed both early and late outcomes after thoracotomy conversion from VATS.
  
  
  METHODS
  From December 2003 to December 2008, a total of 738 VATS lobectomies were attempted. Among them were 34 unplanned conversions to open thoracotomy. Patient characteristics, operative data, and early and late postoperative outcomes were analyzed retrospectively.
  
  
  RESULTS
  Among the 34 conversion cases, 26 patients had lung cancer and 8 had benign lung disease. The conversion rate was 4.61%. Left and right upper lobectomies were most often associated with unplanned conversions. Conversion was classified into five groups: (1) problems related to anthracofibrosis of hilar lymph nodes in 14 patients; (2) intraoperative vessel or bronchus injury in 11 patients; (3) fused interlobar fissure in 4 patients; (4) oncologic problems, including mediastinal or hilar lymph node metastasis in 2 patients; and (5) vascular anomalies in 3 patients. There was one death due to postoperative pneumonia in a patient with multiple co-morbidities. Two patients had an episode of pneumonia. The mean hospital stay was 10 days, and the median follow-up period was 30.0 ± 11.47 months. Three patients with lung cancer developed recurrent disease, all of whom were found to have stage III disease. No cancer-related death occurred. There was no significant difference in survival or recurrence between patients with conversion and those with successful VATS. However, the operating time and hospital stay were significantly longer in conversion patients.
  
  
  CONCLUSIONS
  Our data support the claim that VATS lobectomy can be safely performed with an acceptable conversion rate. Unplanned conversion to open thoracotomy does not appear to compromise the prognosis.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
authors.forename: Joon Suk
authors.initials: JS
authors.lastname: Park
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Choi
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013908:Thoracotomy / Q000379:methods / Q000401:mortality; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome