Table 1. Summary of studies in VATS conversion to thoracotomy included in the meta-analysis.
| Study | Years | Country | Study type | Resection | N | Conversion rate | Emergent conversion rate | Risk factors for conversion | Downs & Black Score |
|---|---|---|---|---|---|---|---|---|---|
| Amore et al. | 2011–2017 | Italy | Single center, retrospective | Lobectomy | 573 | 6.98% | 0.70% | NR | 15 |
| Augustin et al. | 2009–2012 | Austria | Single center, retrospective | Anatomical resection | 232 | 6.47% | 2.59% | Univariate: induction therapy (P=0.019) | 19 |
| Multivariate: induction therapy & tumor size | |||||||||
| Bongiolatti et al. | 2014–2017 | Italy | Multi-center, retrospective | Lobectomy | 4,629 | 9.33% | NR | Univariate: age >70 (P=0.014); male (P<0.01); clinical node involvement (P<0.01) | 18 |
| Byun et al. | 2005–2013 | Korea | Single center, retrospective, matched case control | Lobectomy | 1,110 | 6.22% | NR | Univariate: older age (P=0.009); history of TB (P=0.029); COPD (P=0.049); lower FEV1 (P=0.023); greater smoking pack year (P=0.042); fibrocalcified nodes (P<0.001) | 19 |
| Multivariate: age >65 (P=0.031); FEV1 <1.8 (P=0.005); fibrocalcified nodes (P=0.020) | |||||||||
| Foundrain et al. | 2011–2017 | France | Single center, retrospective | Anatomical resection | 309 | 18.12% | NR | NR | 18 |
| Gazala et al. | 2006–2008 | Canada | Single center, retrospective | Lobectomy | 237 | 13.50% | 0.00% | NR | 15 |
| Hendriksen et al. | 2010–2015 | United States | Retrospective database review | Lobectomy | 39,063 | 15.44% | NR | Logistic regression: age 70–79 (P<0.001); age >80 (P=0.002); community hospital (P<0.001); tumor size 4.5–8.4 cm (P<0.001); stage T3 (P<0.001); stage T4 (P=0.037); N1 or N2 disease (P<0.001) | 18 |
| Kim et al. | 2013–2016 | Korea | Single center, retrospective | Anatomical resection | 89 | 42.70% | NR | Univariate: age (P<0.01); enlarged lymph node on CT (P=0.4); FDG uptake except for main mass and node mets (P<0.01); tumor location (P=0.039) | 17 |
| Multivariate: age (P=0.049); tumor location (P=0.039) | |||||||||
| Li et al. | 2006–2010 | China | Single center, retrospective | Lobectomy | 306 | 8.82% | NR | No significant risk factors | 16 |
| Li & Wang | 2006–2013 | China | Single center, retrospective | Anatomical resection | 1,006 | 8.25% | 1.29% | NR | 19 |
| Lim et al. | 2011–2015 | Korea | Single center, retrospective | Lobectomy | 235 | 23.40% | NR | Univariate: age >65 (P<0.01); tumor stage (P=0.015) | 16 |
| Multivariate: attenuation of PLN or PCS on CT (P=0.005) | |||||||||
| Matsuoka et al. | 2009–2014 | Japan | Single center, retrospective | Anatomical resection | 1566 | 2.49% | NR | Univariate: male sex (P=0.042); smoking (P=0.0295); induction therapy (P=0.0214); tumor diameter (P=0.0075); advanced clinical stage (P=0.0002) | 19 |
| Multivariate: advanced clinical stage (P=0.0346) | |||||||||
| Park et al. | 2003–2008 | Korea | Single center, retrospective | Lobectomy | 738 | 4.61% | NR | NR | 18 |
| Puri et al. | 2004–2012 | United States | Single center, retrospective | Lobectomy | 604 | 14.40% | 3.31% | Logistic regression: male gender (P=0.043) | 21 |
| Samson et al. | 2003–2009 | United States | Multi-center, retrospective | Lobectomy | 193 | 23.32% | NR | Univariate: calcification score (P=0.04) | 18 |
| Multivariate: calcification score (P=0.03) | |||||||||
| Sawada et al. | 2003–2007 | Japan | Single center, retrospective | Lobectomy | 492 | 4.88% | 4.88% | NR | 18 |
| Sezen et al. | 2012–2016 | Turkey | Single center, retrospective | Lobectomy | 147 | 12.24% | NR | Univariate: age >70 (P=0.001); cardiac comorbidity (P=0.01); lymph node mets (P=0.045) | 18 |
| Multivariate: age>70 (P=0.015) | |||||||||
| Smith et al. | 2009–2014 | Argentina | Single center, retrospective | Lobectomy | 154 | 13.64% | 3.25% | Univariate: tumor size >3 cm (P=0.039) | 19 |
| Tong et al. | 2016–2018 | China | Single center, retrospective | Anatomical resection | 20,565 | 1.00% | 0.18% | Univariate: age (P<0.001); BMI (P<0.001); induction therapy (P=0.003); tumor size, stage, nodal involvement (P<0.001); tumor location (P=0.002) | 19 |
| Multivariate: age >60 (P<0.001); male (P=0.022); induction therapy (P=0.007); tumor size >1.4 cm (P=0.036); clinical node involvement (P=0.01); lymph node calcification (P<0.001); pleural adhesions (P<0.001) | |||||||||
| Vallance et al. | 2010–2015 | United Kingdom | Single center, retrospective | Lobectomy | 684 | 10.96% | 0.73% | NR | 19 |
N, number of VATS; NR, not recorded.