Analysis of lymph node impact on conversion of complete thoracoscopic lobectomy to open thoracotomy

BACKGROUND: The aim of the study was to analyze the influence of lymph nodes in conversion thoracotomy and its measurements. METHOD: Between September 2006 to April 2013, 1006 patients (545 men, 461 women, median age 60 years, range: 13 to 86 years) received a complete thoracoscopic lobectomy. The main procedure was complete video-assisted anatomical lobectomy with mediastinal lymphadenectomy. RESULTS: All procedures were carried out smoothly without serious complication. Eighty-three cases were converted to thoracotomy (8.2%), including 70 cases of initiative conversion and 13 of passive conversion, in which 59 cases had interference by doornail lymph nodes. The average operative time was significantly longer (272.7 ± 67.2 vs. 186.9 ± 58.1 minutes, P = 0.001); the average blood loss was significantly increased (564.2 ± 507.7 ml vs. 158.0 ± 121.0 ml, P = 0.001); and the drainage time and postoperative hospital stay were significantly longer (8.9 ± 5.0 vs. 6.6 ± 3.5 days, P = 0.001; 12.5 ± 7.7 vs. 9.2 ± 5.8 days, P = 0.001, respectively) in the conversion thoracotomy compared with the complete endoscopic surgery group. CONCLUSION: Interference of the lymph nodes was the main reason for conversion to thoracotomy on video-assisted thoracoscopic lobectomy, which prolonged operative time, increased the blood loss during surgery, and delayed postoperative recovery. Selecting the proper indication of conversion thoracotomy may reduce the negative effects.