The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database
Objectives: Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/2/410 |
| _version_ | 1797444848997892096 |
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| author | Luca Bertolaccini Giulia Fornaro Oriana Ciani Elena Prisciandaro Roberto Crisci Rosanna Tarricone Lorenzo Spaggiari |
| author_facet | Luca Bertolaccini Giulia Fornaro Oriana Ciani Elena Prisciandaro Roberto Crisci Rosanna Tarricone Lorenzo Spaggiari |
| author_sort | Luca Bertolaccini |
| collection | DOAJ |
| description | Objectives: Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii) to assess the impact of surgical experience in VATS lobectomy on conversion rate and patient health-related quality of life. Methods: We extracted detailed information on VATS lobectomy procedures performed consecutively (2014–2019). Predictors of conversion were assessed with univariable and multivariable logistic regressions. To assess the impact of VATS lobectomy experience, observations were divided according to surgeons’ experiences with VATS lobectomy. The impact of VATS lobectomy experience on conversion and occurrence of postoperative complications was evaluated using logistic regressions. The impact of VATS lobectomy experience on EuroQoL-5D (EQ-5D) scores at discharge was assessed using Tobit regressions. Results: A total of 11,772 patients underwent planned VATS for non-small-cell lung cancer (NSCLC), with 1074 (9.1%) requiring conversion to thoracotomy. The independent predictors at multivariable analysis were: FEV1% (OR = 0.99; 95% CI: 0.98–0.99, <i>p</i> = 0.007), clinical nodal involvement (OR = 1.43; 95% CI: 1.08–1.90, <i>p</i> = 0.014). Experienced surgeons performed 4079 (34.7%) interventions. Experience in VATS lobectomy did not show a relevant impact on the risk of open surgery conversion (<i>p</i> = 0.13) and postoperative complications (<i>p</i> = 0.10), whereas it showed a significant positive impact (<i>p</i> = 0.012) on EQ-5D scores at discharge. Conclusions: Clinical nodal involvement was confirmed as the most critical predictor of conversion. Greater experience in VATS lobectomy did not decrease conversion rate and postoperative complications but was positively associated with postoperative patient quality of life. |
| first_indexed | 2024-03-09T13:18:23Z |
| format | Article |
| id | doaj.art-59435396f0e547cf84b186ec2afc551a |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T13:18:23Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-59435396f0e547cf84b186ec2afc551a2023-11-30T21:33:29ZengMDPI AGCancers2072-66942023-01-0115241010.3390/cancers15020410The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical DatabaseLuca Bertolaccini0Giulia Fornaro1Oriana Ciani2Elena Prisciandaro3Roberto Crisci4Rosanna Tarricone5Lorenzo Spaggiari6Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, ItalyCentre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, ItalyCentre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, ItalyDepartment of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, ItalyDepartment of Life, Health and Environmental Sciences, Thoracic Surgery Unit, University of L’Aquila, 64100 Teramo, ItalyCentre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, ItalyDepartment of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, ItalyObjectives: Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii) to assess the impact of surgical experience in VATS lobectomy on conversion rate and patient health-related quality of life. Methods: We extracted detailed information on VATS lobectomy procedures performed consecutively (2014–2019). Predictors of conversion were assessed with univariable and multivariable logistic regressions. To assess the impact of VATS lobectomy experience, observations were divided according to surgeons’ experiences with VATS lobectomy. The impact of VATS lobectomy experience on conversion and occurrence of postoperative complications was evaluated using logistic regressions. The impact of VATS lobectomy experience on EuroQoL-5D (EQ-5D) scores at discharge was assessed using Tobit regressions. Results: A total of 11,772 patients underwent planned VATS for non-small-cell lung cancer (NSCLC), with 1074 (9.1%) requiring conversion to thoracotomy. The independent predictors at multivariable analysis were: FEV1% (OR = 0.99; 95% CI: 0.98–0.99, <i>p</i> = 0.007), clinical nodal involvement (OR = 1.43; 95% CI: 1.08–1.90, <i>p</i> = 0.014). Experienced surgeons performed 4079 (34.7%) interventions. Experience in VATS lobectomy did not show a relevant impact on the risk of open surgery conversion (<i>p</i> = 0.13) and postoperative complications (<i>p</i> = 0.10), whereas it showed a significant positive impact (<i>p</i> = 0.012) on EQ-5D scores at discharge. Conclusions: Clinical nodal involvement was confirmed as the most critical predictor of conversion. Greater experience in VATS lobectomy did not decrease conversion rate and postoperative complications but was positively associated with postoperative patient quality of life.https://www.mdpi.com/2072-6694/15/2/410lung cancerVATS lobectomysenioritysurgical experiencequality of life |
| spellingShingle | Luca Bertolaccini Giulia Fornaro Oriana Ciani Elena Prisciandaro Roberto Crisci Rosanna Tarricone Lorenzo Spaggiari The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database Cancers lung cancer VATS lobectomy seniority surgical experience quality of life |
| title | The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database |
| title_full | The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database |
| title_fullStr | The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database |
| title_full_unstemmed | The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database |
| title_short | The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database |
| title_sort | impact of surgical experience in vats lobectomy on conversion and patient quality of life results from a comprehensive national video assisted thoracic surgical database |
| topic | lung cancer VATS lobectomy seniority surgical experience quality of life |
| url | https://www.mdpi.com/2072-6694/15/2/410 |
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