B-002
CONVERSION DUE TO VASCULAR INJURY DURING VIDEO-ASSISTED THORACOSCOPIC SURGERY LOBECTOMY Free

Objectives: VATS lobectomy experienced a dramatic growth worldwide in the last 25 years. Vascular injuries are known to be among the most serious causes of unplanned emergency conversion. We assessed the incidence of vascular injuries and analysed the related risk factors using our prospective National VATS lobectomy registry.

Methods: A National Registry for VATS lobectomy established in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3700 patients enrolled, only information from Units with >100 VATS lobectomies were retrospectively analysed. Unpaired Student’s t-tests, Fisher’s exact-tests, Pearson’s χ², Spearman’s-rho were applied as needed. Univariate analysis was performed on selected variables; significant variables (P < 0.30) were entered into a Cox multivariable logistic regression model.

Results: Ten institutions contributed a total of 1679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Seniority was inversely related to the risk of vascular injuries (rho=–0.54). Univariate analysis showed that age, gender, surgical volume activity, Charlson Index Score and number of resected lymph-nodes were crucial variables (P < 0.30). Unexpectedly, triportal vs. biportal vs. uniportal approaches were not significantly associated with injuries leading to conversion. Multivariate analysis showed that only number of resected lymph-nodes, VATS experience ratio (i.e. number of VATS lobectomies/total lobectomies performed in same year at same centre), and surgical volume of centre were variables significantly associated with the risk of conversion. Emergency thoracotomy was strongly correlated with postoperative morbidity (rho=0.68).

Conclusions: Vascular injuries during VATS lobectomies represent infrequent complications, but directly affect postoperative outcome. Not surprisingly, the surgical volume and the patient comorbidities are among the strongest predictive factors for conversion. The number of ports used for VATS lobectomy did not influence the risk of vascular damages while the number of resected lymph-nodes strongly increased the risk of injuries and conversion.

Disclosure: No significant relationships.