Systematic node dissection by VATS is not inferior to that through an open thoracotomy: A comparative clinicopathologic retrospective study

Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections?

“…We experienced 14.8% and 10% of 30-day complication rate in group 1 and group 2 respectively which is in line with other series (1)(2)(3)(4)13,17,24). In group 1, 1 (3.7%) patient referred a post-operative hoarseness, that we linked to VM, even if vocal cords were apparently normal; the symptom resolved spontaneously in few weeks.…”

“…A wide number of reports have demonstrated that VATS lobectomy can be performed with minimal complications and a shorter length of stay compared with open lobectomy (1-5). However, several thoracoscopic approaches and technical options have been described: the number of ports (uniportal vs. bi-or three-port technique), the size and position of the incisions, the different approach to the hilum (anterior, posterior, inferior) and the amount of anatomical hilar and interlobar dissection are main topics of an ongoing discussion or a matter of choice for the surgeon approaching VATS lobectomy (13)(14)(15)(16). We evaluated VATS lymphadenectomy during VMPR on a series of 146 consecutive patients, following the same pre-operative indications for invasive mediastinal staging (NCCN 2010 guidelines), and operated with the same standard three-port anterior approach (15): a <5 cm utility incision, without rib spreading or soft tissue retraction; other two ports (<1.5 cm), placed one anteriorly at the level of the diaphragm and one posteriorly at the same level in a straight line down from the scapula.…”

Thoracoscopic lobectomy for locally advanced-stage non-small cell lung cancer is a feasible and safe approach: analysis from multi-institutional national database

“…Almost 25% of patients had chemotherapy before surgery, but in this cohort, we included different cases that could be differently evaluated on the basis of the clinical experience of the recruiting centre. The initial doubts about VATS-L oncological adequacy for early-stage NSCLC have been overcome, as demonstrated by several authoritative papers (1)(2)(3)(4)(5)(6)(7)(8)(9)(10); the minimally invasive technique and the traditional open technique have proven to be equivalent in terms of overall survival and disease free-survival also for locally advanced NSCLC (10)(11)(12)(13). Unfortunately, our study lacks of mid-and long-term survival results; however, we have some valid oncological data such as the extent of lymphadenectomy and the resection margin status.…”

“…Furthermore, several and authoritative authors demonstrated the efficacy of VATS lobectomy in terms of oncological results and validity of mediastinal intra-operative staging (7)(8)(9)(10), but the use of VATS-L for locally advanced-stage NSCLC is not well established. Some preliminary and single-centre retrospective studies have shown that VATS-L is feasible, safe and effective with long-term oncologic outcomes comparable to lobectomy via thoracotomy (11)(12)(13).…”

The Era of VATS Lobectomy

“…There are similarities in all studies comparing lymph node dissection by VATS to thoracotomy: the number of lymph nodes resected by VATS tend to be slightly less than in open thoracotomy, but statistically difference cannot be proven (Denlinger et al, 2010;Kondo et al, 1998;Scott et al, 2010;Watanabe et al, 2005). Technically lymph node dissection by VATS is possible (Cassina et al, 1995), concentration and focussing are required.…”