Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Video-assisted thoracic surgery (VATS) lobectomy is increasingly used for early-stage lung cancer.
• Concerns exist regarding the thoroughness of lymph node assessment in VATS compared to traditional thoracotomy.

Purpose of the Study:

• To compare the adequacy of lymph node assessment between VATS lobectomy and open lobectomy for clinical stage I non-small cell lung cancer.
• To evaluate the impact of surgical approach on lymph node sampling and patient survival.

Main Methods:

• Retrospective analysis of clinical stage I non-small cell lung cancer patients undergoing VATS or open lobectomy.
• Evaluation of total lymph nodes, N2 nodes, and nodes per station sampled.
• Correlation of nodal sampling with surgical approach and lobe location.

Main Results:

• Fewer total lymph nodes (7.4 vs 8.9) and N2 nodes (2.5 vs 3.7) were sampled with VATS compared to thoracotomy (p=0.029 and p=0.004, respectively).
• No significant difference in N1 node sampling (p=0.592).
• Thoracotomy yielded more station 7 nodes (1.2 vs 0.6, p=0.002), particularly for left-sided and upper lobe resections.
• No difference in 2-year survival between VATS and open lobectomy (81% vs 83%, p=0.4).

Conclusions:

• Early VATS lobectomy experience shows reduced lymph node sampling compared to open lobectomy.
• Despite fewer nodes, VATS did not compromise patient survival.
• Findings emphasize the need for a refined, focused lymph node sampling strategy in VATS lobectomy.