Thoracotomy Versus Uniportal and Multiportal Video-Assisted Thoracoscopic Approaches for Lymph Node Dissection in...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Video-assisted thoracoscopic surgery (VATS) is increasingly preferred over thoracotomy for lung cancer resection.
• Optimal lymph node dissection is crucial for lung cancer staging and treatment.
• Comparative effectiveness of VATS approaches versus thoracotomy for lymphadenectomy requires further investigation.

Purpose of the Study:

• To compare the effectiveness of thoracotomy, multiportal VATS, and uniportal VATS in lymph node dissection for primary lung cancer.
• To evaluate the impact of surgical learning phases on lymphadenectomy outcomes.

Main Methods:

• Retrospective review of 763 lung cancer patients undergoing resection (October 2001-January 2024).
• Stratification into early, intermediate, and late VATS learning phases.
• Propensity score matching (1:1) based on patient demographics and tumor staging.
• Comparison of dissected lymph node counts using Kruskal-Wallis test.

Main Results:

• Thoracotomy (n=469) yielded a higher mean lymph node count (22.1) compared to multiportal VATS (n=147, 16.8) and uniportal VATS (n=150, 12.8) (P < 0.001).
• After propensity score matching, differences in lymph node counts between thoracotomy and VATS approaches were not statistically significant in the late learning phase (P = 0.158).

Conclusions:

• Thoracotomy facilitates a more comprehensive lymphadenectomy in lung cancer surgery.
• Multiportal and uniportal VATS approaches demonstrate comparable lymphadenectomy outcomes to thoracotomy after the learning curve.
• VATS techniques are evolving towards achieving optimal lymph node dissection effectiveness.