Causes and Consequences of Conversion during anatomical VATS resections

Background Over the past two decades, a minimally invasive approach to anatomic lung resection has become the standard of care. Despite technical improvements, a small percentage of patients still require conversion to an open thoracotomy during surgery. This analysis aims to identify causes and consequences of these conversions and determine potential risk prediction factors for conversion.

Methods & Materials All patients who underwent an anatomical VATS resection between 2009 and 2020 at our center were included (n=948). Patient data was analyzed through a retrospective review of charts and medical records.

Results Overall, 46 (4.9%) of 948 patients underwent conversion from VATS to open thoracotomy.

Significantly more conversions were observed in male patients (32 men vs. 14 women; p=0.02). We did not find any other differences in patient demographics.

Further, variances were identified in tumor characteristics such as diameter (31.7 mm vs. 26.1 mm; p=0.028) and tumor localization. Central tumor localization was more common in converted patients (47.8% vs. 25.1%; p<0.001), additionally they were more likely to have received neoadjuvant treatment (26.1% vs. 8.8%; p<0.001).

Significantly longer durations of surgery were observed in converted patients (238 min vs. 152 min; p<0.001). Hospitalization time was also longer for converted patients (12.5 vs. 8 days; p<0.001).

There was a trend to more R1 resections in converted cases than in the VATS group (4.3% vs. 0.7%; p=0.0535).

Conclusion Our analysis was able to identify potential risk factors for conversion, including male gender, tumor size, localization, and prior neoadjuvant treatment. A conversion typically results in longer surgical procedures as well as duration of hospital stay. Our risk factors help to anticipate complex cases with a higher risk of conversion and can be used to optimize perioperative patient care.

Publication History

Article published online:
25 August 2025