Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11643

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    P2.07-048 - Causes, predictors and consequences of conversions in VATS lobectomy for NSCLC (ID 3408)

    09:30 - 09:30  |  Author(s): F. Augustin
    • Abstract

    Background
    To analyze causes, predictors and consequences of conversions to open surgery in VATS lobectomy.

    Methods
    Retrospective analysis of a prospectively maintained database.

    Results
    Since February 2009, 297 patients with NSCLC were scheduled for VATS anatomical resections. Conversion to open surgery was necessary in 22 patients (7.4%). Reasons for conversion were bleeding in 10, oncologic reason in 8 and technical considerations in 4 patients (adhesions after pleuritis or radiotherapy for other tumors: 3, limited space: 1). In univariate analysis, conversion rate was significantly higher in patients after neoadjuvant therapy (21% vs 4.3%, p=0.002). There was a statistical trend for higher conversion rate in patients during the first half of the series (9.5% vs 3.4%, p=0.062) and larger tumor size (T1 vs >T1, 4.8% vs 12.9%, p=0.098). The conversion rate was not influenced by age of the patient, nodal stage (pN0 vs pN+), body mass index, COPD, FEV1, or benign disease. Conversion did not translate into higher overall postoperative complication rates (33.3% vs 29.5%), longer chest drain duration (median 5 vs 5 days), or mortality (0% vs 2%). However, length of hospital stay was significantly longer in the conversion group (median 10 vs 6 days, p=0.0066).

    Conclusion
    Neoadjuvant therapy is an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Patients after neoadjuvant therapy should be selected carefully for a VATS approach. Conversion to thoracotomy did not increase the postoperative complication or mortality rate, but significantly increased the length of stay.

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12543

    +

    P3.07-048 - VATS lobectomy for NSCLC in Germany - results of a nationwide survey (ID 3412)

    09:30 - 09:30  |  Author(s): F. Augustin
    • Abstract

    Background
    Despite increasing evidence of safety and efficacy of VATS lobectomy for early stage NSCLC, there has been persistent reluctance for this technique among thoracic surgeons in central Europe. Concerns have existed with regard to oncologic safety and the feasibility and accuracy of hilar and mediastinal lymph node dissection. Only recently the VATS approach has gained some increasing acceptance but no data exist regarding application and indication of the VATS approach for NSCLC in Germany.

    Methods
    A survey (12 questions) was performed among the thoracic surgical units in Germany. Questions focused on volume, indication, technique and distribution of VATS lobectomy for NSCLC.

    Results
    The response rate was 65% (25 units). Most units started the VATS lobectomy program only within the last 5 years and sofar performed up to 100 procedures, only 4 centers performed more than 300 procedures. Most centers consider NSCLC stages IA-IIB for a VATS approach, 4 units (16%) approach tumors up to stage IIIA by VATS. All units operate via an anterior approach, most (80%) use 3 incisions. In addition to standard lobectomies, 15 (60%) units also perform anatomical segmentectomies, 2 (8%) centers bronchial sleeve resections and 1 (4%) center pneumonectomies by VATS. 24 (96%) units perform systematic lymph node dissection, 3 centers perform VAMLA (Video Assisted Mediastinal LympAdenectomy). In most units (14, 56%) 2-3 surgeons participate in the VATS lobectomy program.

    Conclusion
    In Germany, the VATS approach for anatomical resections for NSCLC has been increasingly adopted only within the last 5 years. However, even in 2013, only approximately 15% of all lobectomies are performed by VATS, which is a low rate when compared to the US, Great Britain and some Asian countries.