Thorac Cardiovasc Surg
DOI: 10.1055/s-0043-1776706
Original Thoracic

Outcomes after Conversion from Video-Assisted Thoracoscopic Lobectomy to Thoracotomy

1   Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
1   Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
Kandadai Rammohan
1   Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
Eustace Fontaine
1   Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
Vijay Joshi
1   Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
Stuart Grant
2   Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
Felice Granato
1   Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
› Author Affiliations


Background Lung cancer resections are increasingly being performed via video-assisted thoracoscopic surgery (VATS). Conversion to thoracotomy can occur for many reasons and may affect outcomes. The objective of this study was to investigate the impact of VATS conversion on short- and mid-term outcomes and identify reasons for conversion.

Methods Consecutive patients undergoing lobectomy for primary non-small cell lung cancer between 2012 and 2019 in a single UK center were included. Primary outcomes were 90-day mortality, intraoperative conversion, and overall survival. Reasons for conversion were defined as bleeding or nonbleeding. Outcomes were compared between groups using univariable analysis. Multivariable logistic regression analysis was performed to identify risk factors for conversion.

Results A total of 2,622 patients were included with 20.6% (n = 541) completing surgery via VATS and 79.4% (n = 2,081) via thoracotomy. The rate of completed VATS surgery increased significantly over time (2012: 6.9%, 2019: 55.1%, p < 0.001). Overall conversion rate was 14.3% (n = 90/631) and has reduced significantly over time (p < 0.001). The rate of conversion due to intraoperative bleeding was 31.1% (n = 28/90). Obesity, male sex, and stage III disease were independent risk factors for conversion. The 90-day mortality rate after conversion was not significantly different from the rate for planned thoracotomy (3.3 vs. 3.4%, p = 0.987). There was no significant difference in overall survival between patients experiencing intraoperative conversion and those undergoing planned thoracotomy (p = 0.135).

Conclusion This study demonstrates comparable outcomes for patients undergoing conversion from VATS to those undergoing planned surgery via thoracotomy. It remains unclear if reason for conversion is associated with outcomes.

Data Availability Statement

Data are available from the authors upon reasonable request.

Publication History

Received: 06 June 2023

Accepted: 10 October 2023

Article published online:
15 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Ginsberg RJ, Rubinstein LV. Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1.  N0 non-small cell lung cancer. Ann Thorac Surg 1995; 60 (03) 615-622 , discussion 622–623
  • 2 Hytych V, Horazdovsky P, Pohnan R. et al. VATS lobectomy, history, indication, contraindication and general techniques. Bratisl Lek Listy 2015; 116 (07) 400-403
  • 3 Pons A, Lim E. Thoracic surgery in the UK. J Thorac Dis 2022; 14 (02) 575-578
  • 4 Cattaneo SM, Park BJ, Wilton AS. et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg 2008; 85 (01) 231-235 , discussion 235–236
  • 5 Swanson SJ, Herndon II JE, D'Amico TA. et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802–a prospective, multi-institution feasibility study. J Clin Oncol 2007; 25 (31) 4993-4997
  • 6 Cao C, Manganas C, Ang SC, Peeceeyen S, Yan TD. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg 2013; 16 (03) 244-249
  • 7 Lim E, Batchelor TJP, Dunning J. et al. Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer. NEJM Evid 2022;1(03):
  • 8 SCTS.. The Third National Thoracic Surgery Activity and Outcomes Report; 2018. Available at:
  • 9 Puri V, Patel A, Majumder K. et al. Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg 2015; 149 (01) 55-61 , 62.e1
  • 10 Sawada S, Komori E, Yamashita M. Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy. Eur J Cardiothorac Surg 2009; 36 (03) 487-490
  • 11 Amore D, Di Natale D, Scaramuzzi R, Curcio C. Reasons for conversion during VATS lobectomy: what happens with increased experience. J Vis Surg 2018; 4: 53-53
  • 12 Samson P, Guitron J, Reed MF, Hanseman DJ, Starnes SL. Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg 2013; 145 (06) 1512-1518
  • 13 Jones RO, Casali G, Walker WS. Does failed video-assisted lobectomy for lung cancer prejudice immediate and long-term outcomes?. Ann Thorac Surg 2008; 86 (01) 235-239
  • 14 Rami-Porta R, Bolejack V, Giroux DJ. et al; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members and Participating Institutions. The IASLC lung cancer staging project: the new database to inform the eighth edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2014; 9 (11) 1618-1624
  • 15 Taylor M, Szafron B, Martin GP. et al; North West Thoracic Surgery Collaborative (NWTSC). External validation of six existing multivariable clinical prediction models for short-term mortality in patients undergoing lung resection. Eur J Cardiothorac Surg 2021; 59 (05) 1030-1036
  • 16 Fourdrain A, Georges O, Lafitte S, Meynier J, Berna P. Intraoperative conversion during video-assisted thoracoscopy resection for lung cancer does not alter survival. Interact Cardiovasc Thorac Surg 2021; 33 (01) 68-75
  • 17 Seitlinger J, Olland A, Guinard S, Massard G, Falcoz PE. Conversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lung resection: how does it affect perioperative outcomes?. Interact Cardiovasc Thorac Surg 2021; 32 (01) 55-63
  • 18 Sezen CB, Bilen S, Kalafat CE. et al. Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis. Gen Thorac Cardiovasc Surg 2019; 67 (11) 969-975
  • 19 Bongiolatti S, Gonfiotti A, Viggiano D. et al; Italian VATS Group. Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database. Surg Endosc 2019; 33 (12) 3953-3962
  • 20 Gazala S, Hunt I, Valji A, Stewart K, Bédard ER. A method of assessing reasons for conversion during video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg 2011; 12 (06) 962-964