Preoperative planning programme in minimally invasive lung surgery reduces intraoperative adverse events

Objectives: While minimally invasive surgery (MIS) is the preferred approach in patients with early-stage lung cancer, intraoperative adverse events (IOAE) may still occur. The objective of this study was to assess the impact of a dedicated preoperative planning program on adverse event occurrence.

Methods: A single-centre cross-sectional comparative study was conducted, including all patients with proven/suspected lung cancer undergoing curative MIS, prior (September 2021-October 2022) and after (November 2022-January 2024) the implementation of a preoperative planning program. The preoperative planning program consisted of a weekly assessment of upcoming surgical cases, evaluating surgical strategy, anatomical variations and anticipating surgical difficulties. Data were prospectively collected. The primary outcome was the rate of IOAE. Secondary outcomes were conversion rate, healthcare-associated adverse events and postoperative morbi-mortality.

Results: We included 553 patients, 290 without preoperative planning and 263 undergoing a preoperative planning program. The overall IOAE rate was 11.4%, significantly lower after preoperative planning (7.6% vs 14.8%, P = 0.008). The overall healthcare-associated adverse events rate was 23.2%, significantly lower after preoperative planning (17.1% vs 28.6%, P = 0.0014). There were no statistical differences before and after preoperative planning for conversion rate (8.37% vs 10.7%, P = 0.354), complication rate (33.1% vs 34.5%, P = 0.73) and 90-day mortality (0.38% vs 2.07%, P = 0.126). Preoperative planning program impacted surgical strategy in 61/263 patients (23.2%) including a change in the extent of resection in 25/263 patients (9.5%).

Conclusions: Implementation of a systematic preoperative planning program in MIS for lung cancer decreases IOAE enabling an improvement in surgical safety.