BACKGROUND: Concerns remain unresolved regarding the safety of unplanned conversion to open thoracotomy during video-assisted thoracic surgery (VATS) lobectomy. We analyzed both early and late outcomes after thoracotomy conversion from VATS.

METHODS: From December 2003 to December 2008, a total of 738 VATS lobectomies were attempted. Among them were 34 unplanned conversions to open thoracotomy. Patient characteristics, operative data, and early and late postoperative outcomes were analyzed retrospectively.

RESULTS: Among the 34 conversion cases, 26 patients had lung cancer and 8 had benign lung disease. The conversion rate was 4.61%. Left and right upper lobectomies were most often associated with unplanned conversions. Conversion was classified into five groups: (1) problems related to anthracofibrosis of hilar lymph nodes in 14 patients; (2) intraoperative vessel or bronchus injury in 11 patients; (3) fused interlobar fissure in 4 patients; (4) oncologic problems, including mediastinal or hilar lymph node metastasis in 2 patients; and (5) vascular anomalies in 3 patients. There was one death due to postoperative pneumonia in a patient with multiple co-morbidities. Two patients had an episode of pneumonia. The mean hospital stay was 10 days, and the median follow-up period was 30.0 ± 11.47 months. Three patients with lung cancer developed recurrent disease, all of whom were found to have stage III disease. No cancer-related death occurred. There was no significant difference in survival or recurrence between patients with conversion and those with successful VATS. However, the operating time and hospital stay were significantly longer in conversion patients.

CONCLUSIONS: Our data support the claim that VATS lobectomy can be safely performed with an acceptable conversion rate. Unplanned conversion to open thoracotomy does not appear to compromise the prognosis.