Is the Epithor conversion score reliable in robotic-assisted surgery anatomical lung resection?

OBJECTIVES Despite an improvement in surgical abilities, the need for an intraoperative switch from a minimally invasive procedure towards an open surgery (conversion) still remains. To anticipate this risk, the Epithor conversion score (ECS) has been described for video-assisted thoracoscopic surgery (VATS). Our objective was to determine if this score, developed for VATS, is applicable in robotic-assisted thoracoscopic surgery (RATS).METHODS This was a retrospective monocentric study from January 2006 to June 2022, and data were obtained from the EPITHOR database. Patients included were those who underwent anatomic lung resection either by VATS or RATS. The ECS was calculated for all patients studied. Discrimination and calibration of the test were measured by the area under the curve and Hosmer-Lemeshow test.RESULTS A total of 1685 were included. There were 183/1299 conversions in the VATS group (14.1%) and 27/386 conversions in the RATS group (6.9%). Patients in the RATS group had fewer antiplatelet therapy and peripheral arterial disease. There were more segmentectomies in the VATS group. As for test discrimination, the area under the curve was 0.66 [0.56-0.78] in the RATS group and 0.64 [0.60-0.69] in the VATS group. Regarding the calibration, the Hosmer-Lemeshow test was not significant for both groups but more positive (better calibrated) for the VATS group (P = 0.12) compared to the RATS group (P = 0.08).CONCLUSIONS The ECS seems applicable for patients operated with RATS, with a correct discrimination but a lower calibration performance for patients operated with VATS. A new score could be developed to specifically anticipate conversion in patients operated on by RATS. Anatomical resection with systematic lymph node dissection is the treatment of choice in patient with operable early-stage non-small-cell lung cancer, favouring minimally invasive surgical approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS).

Automated summary

This study aimed to determine if the Epithor conversion score (ECS), developed for video-assisted thoracoscopic surgery (VATS), is applicable in robotic-assisted thoracoscopic surgery (RATS). The results showed that the ECS has good discrimination in RATS patients but lower calibration performance in VATS patients. Therefore, a new score may need to be developed to anticipate surgery conversion in RATS patients.