Background: Video-assisted thoracic surgery (VATS) is increasingly used in the surgical treatment of early lung cancer, but the oncological benefits are still controversial. We aimed to compare videoassisted lobectomy and open thoracotomy lobectomy in terms of lymphadenectomy and long-term survival depending on the location of lobectomy. Methods: A retrospective, multicenter study was based on the Polish Lung Cancer Study Group and included patients with stage I lung cancer who were surgically treated between 2007 and 2015. We included 1410 patients after video-assisted lobectomy and 4,855 after open thoracotomy. Results: The average number of lymph nodes removed in video-assisted lobectomy was 10.9 and in open thoracotomy lobectomy was 12.9 (P<0.001). The 5-year survival was better in the video-assisted lobectomy group (78.6%) compared to open thoracotomy (73.8%) (P=0.002). Significant differences were found in the case of left lower lobe and left upper lobe lobectomies. Multivariable analysis showed that the prognostic factors for open thoracotomy relative to video-assisted lobectomy are: age over 60 [HR (95% CI): 1.55 (1.17-2.05), P=0.002], female [HR (95% CI): 1.57 (1.07-2.29), P=0.02], squamous cell carcinoma [HR (95% CI): 1.63 (1.12-2.37), P=0.011], left lower lobe [HR (95% CI): 2.69 (1.37-5.27), P=0.004] and left upper lobe [HR (95% CI): 1.53 (1.01-2.33), P=0.047]. Conclusions:The study showed that the number of lymph nodes removed during video-assisted lobectomy is significantly lower than in the open thoracotomy group. The long-term video-assisted lobectomy results were significantly better compared to open thoracotomy. Better long-term results were achieved on the left side of lobectomy.

Background: Non-small cell lung cancer diagnosed in young patients is rare. Younger patients with lung cancer are mostly female and have a more advanced stage at initial diagnosis. To our knowledge, no studies have compared single-surgical treatment in different age groups among women. Our study aimed to elucidate the clinicopathological characteristics and the best strategies for surgically treating young women with non-small-cell lung cancer. Methods:The data were collected retrospectively from the Polish Lung Cancer Study Group database.Women who were surgically treated for non-small-cell lung cancer between 2007 and 2020 were included in the study. The participants (n=11,460) were divided into two subgroups: aged ≤55 and >55 years.

OBJECTIVES We aimed to investigate the clinical significance of left lower paratracheal nodes (#4L) and their impact on survival in patients with left-sided lung cancer. METHODS This was a retrospective analysis of prospective data. The study included 5369 patients who underwent surgery between 2005 and 2015. Six hundred fifty-nine patients underwent #4L dissection (4LND+), and 4710 did not (4LND−). Propensity score matching was used to minimize analytic error (659 vs 659). RESULTS The percentage of #4L metastasis increased with tumour size. Between pT2a and pT2b, it nearly doubled from 8% to 14%. The mean percentage of #4L metastasis in the pN2 group was 46, which was higher in left upper lobectomy compared to left lower lobectomy (63% vs 43%, respectively, P &lt; 0.001). In univariable analysis, no differences in 5-year survival were observed between 4LND+ and 4LND− (48% vs 50%, respectively, P = 0.65). However, we detected a significant difference among non-metastatic 4LND+, 4LND− and metastatic 4LND+ (P &lt; 0.0001). After propensity score matching, there were no significant differences in survival among the pN2 subgroups (pN2a1, pN2a2, pN2b1, pN2b2). Multivariable analysis after propensity score matching for each pN2 subgroup did not confirm the effect of #4L metastasis as an independent prognostic factor. CONCLUSIONS Despite #4L nodes not being an independent prognostic factor in lung cancer, the percentage of nodal metastases notably increases above pT2a grade and is comparable to the percentage of #5 and #7 metastasis. Therefore, lymphadenectomy in advanced stages of cancer could benefit from resections of the #4L nodes.

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