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J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

Development of a Risk Scoring Model to Predict Unexpected Conversion to Thoracotomy during Video-Assisted Thoracoscopic Surgery for Lung Cancer

Ga Young Yoo , M.D.1, Seung Keun Yoon , M.D.1, Mi Hyoung Moon , M.D., Ph.D.1, Seok Whan Moon , M.D., Ph.D.1, Wonjung Hwang , M.D. Ph.D.2, Kyung Soo Kim , M.D., Ph.D.1

Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Kyung Soo Kim
Tel 82-2-2258-6139
Fax 82-594-8644
E-mail cskks@catholic.ac.kr
ORCID
https://orcid.org/0000-0002-3680-9851

This study was presented as an oral presentation at the 54th Annual Meeting of the Korean Society for Thoracic and Cardiovascular Surgery in Pyeongchang, Korea, from November 3–5, 2022.

Received: October 6, 2023; Revised: December 17, 2023; Accepted: January 15, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion.
Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed.
Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy.
Conclusion: We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.

Keywords: Video-assisted thoracic surgery, Conversion, Thoracotomy, Lung neoplasms

Article

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J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

Development of a Risk Scoring Model to Predict Unexpected Conversion to Thoracotomy during Video-Assisted Thoracoscopic Surgery for Lung Cancer

Ga Young Yoo , M.D.1, Seung Keun Yoon , M.D.1, Mi Hyoung Moon , M.D., Ph.D.1, Seok Whan Moon , M.D., Ph.D.1, Wonjung Hwang , M.D. Ph.D.2, Kyung Soo Kim , M.D., Ph.D.1

Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Kyung Soo Kim
Tel 82-2-2258-6139
Fax 82-594-8644
E-mail cskks@catholic.ac.kr
ORCID
https://orcid.org/0000-0002-3680-9851

This study was presented as an oral presentation at the 54th Annual Meeting of the Korean Society for Thoracic and Cardiovascular Surgery in Pyeongchang, Korea, from November 3–5, 2022.

Received: October 6, 2023; Revised: December 17, 2023; Accepted: January 15, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion.
Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed.
Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy.
Conclusion: We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.

Keywords: Video-assisted thoracic surgery, Conversion, Thoracotomy, Lung neoplasms

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