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Lymph Node Dissection in Surgery for Lung Cancer: Comparison of Open vs. Video-Assisted vs. Robotic-Assisted
Alper Toker1, Mehmet Oğuzhan Özyurtkan, Özkan Demirhan
1Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey.
Purpose:
We compared open, video-assisted and robotic-assisted thoracoscopic surgical techniques in the dissection of N1 and N2-level lymph nodes during surgery for lung cancer.
Methods:
This retrospective analysis is based on prospectively collected data of patients (excluding those with N2 or N3 diseases, and sleeve resections) undergoing mediastinal lymph node dissection via open (n = 96), video-assisted thoracoscopy (n = 68), and robotic-assisted thoracoscopy (n = 106). The groups are compared according to the number of lymph node stations dissected, the number of lymph nodes dissected, and the number of lymph nodes dissected by stations.
Results:
Three techniques had similar results based on the number of the dissected N1 and N2-level lymph node stations. Robotic-assisted thoracoscopic surgery yielded significantly more lymph nodes in total (p = 0.0007), and in the number of dissected N1-level nodes (p <0.0001). All techniques yielded similar number of mediastinal lymph nodes, whereas robotic-assisted thoracic surgery (RATS) yielded more station #11 and #12 lymph nodes compared to the other groups.
Conclusions:
In this study, robotic-assisted thoracoscopic surgery has been shown to dissect more lymph nodes at N1 level. However, taking the open approach as standard, we could claim that both currently robotic and video-assisted techniques may provide similar number of dissected N1 and N2-level lymph node stations.
