Can lymph node evaluation be performed well by video-assisted thoracic surgery?

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Systematic review comparing video-assisted thoracic surgery (VATS) and thoracotomy for lymph node (LN) evaluation.
• Investigating the efficacy of VATS in achieving equivalent LN assessment compared to traditional thoracotomy.

Purpose of the Study:

• To compare the lymph node evaluation efficacy between VATS and thoracotomy.
• To determine if VATS provides comparable lymph node staging to thoracotomy.

Main Methods:

• Comprehensive literature search of PubMed, EMBASE, and Cochrane databases.
• Inclusion of studies comparing VATS and thoracotomy regarding lymph node and node station assessment.
• Statistical analysis using Review Manager 5.0 and Stata 12 to calculate mean differences.

Main Results:

• Analysis of 24 studies involving 2,015 patients (VATS) and 3,250 patients (thoracotomy).
• No significant difference in the number of total or mediastinal lymph node stations assessed between VATS and thoracotomy (P > 0.05).
• VATS assessed a similar number of N1 lymph nodes (P = 0.09), but fewer total and mediastinal lymph nodes were harvested compared to thoracotomy (P < 0.00001 and P = 0.01, respectively).

Conclusions:

• VATS and thoracotomy provide equivalent assessment of total and mediastinal lymph node stations.
• While N1 lymph node assessment is comparable, VATS results in a lower yield of total and mediastinal lymph nodes.
• Thoracotomy may offer a more comprehensive harvest of mediastinal lymph nodes.