A Comparison of Surgical Mediastinal Lymph Node Evaluation in Clinical N0 Non-small Cell Lung Cancer between Video-Assisted Thoracoscopic Lobectomy and Open Lobectomy

Background: Video-assisted thoracoscopic surgery (VATS) for lobectomy is increasingly a procedure for early-stage lung cancer surgery, but the controversy remains on the adequacy of the lymph node evaluation.

Objective: To compare the completeness of surgical mediastinal lymph node evaluation between VATS lobectomy and open lobectomy in clinical N0 non-small cell lung cancer (NSCLC).

Material and Methods: Between January 2015 and August 2020, 312 patients who underwent lobectomy for clinical N0 NSCLC at Central Chest Institute of Thailand were reviewed, including 149 patients in VATS lobectomy and 163 patients in open lobectomy. Patient characteristics, surgical outcomes, and lymphadenectomy results were analyzed and compared.

Results: VATS lobectomy had prolonged operative time minute at 198.4±46.8 versus 160.9±73.6 (p≤0.001) but less blood loss at 100 versus 150 (p=0.034) than open lobectomy. The sampling procedure was more frequently performed in the open lobectomy at 44.2% versus 19.5% (p≤0.001), but the VATS lobectomy used the systematic dissection procedure mainly at 67.1% versus 42.9% (p≤0.001). The median overall number of lymph nodes at 19 versus 12 (p≤0.001) and the number of stations N2 nodes at 12 versus 6 (p≤0.001), especially in station 7 were dissected higher in the VATS lobectomy at 130 versus 100 (p≤0.001), but the number of stations N1 nodes was similar. The rate of lymph node upstaging was not significantly different between the two groups (p=0.176). The risk factor for lymph node upstaging was only the tumor size. There were no differences in complication and mortality.

Conclusion: The completeness of mediastinal lymph node evaluation for patients with clinical N0 NSCLC operated on by an experienced surgeon in VATS lobectomy was comparable with the open lobectomy.

Keywords: Video-assisted thoracic surgery; Open thoracotomy; Mediastinal lymph node assessment; Non-small cell lung cancer