Thoracotomy is better than thoracoscopic lobectomy in the lymph node dissection of lung cancer: a systematic review and meta-analysis

Abstract

BackgroundThe aim of this study was to investigate which surgical method is better in lymph node (LN) dissection of lung cancer.MethodsA comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar was performed to identify studies comparing thoracoscopic lobectomy (video-assisted thoracic surgery (VATS) group) and thoracotomy (open group) in LN dissection.ResultsTwenty-nine articles met the inclusion criteria and involved 2763 patients in the VATS group and 3484 patients in the open group. The meta-analysis showed that fewer total LNs (95% confidence interval [CI] −1.52 to −0.73, p < 0.0001) and N2 LNs (95% CI −1.25 to −0.10, p = 0.02) were dissected in the VATS group. A similar number of total LN stations, N2 LN stations, and N1 LNs were harvested in both groups. Only one study reported that fewer N1 LN stations were dissected in the VATS group (1.4 ± 0.5 vs. 1.6 ± 0.6, p = 0.04).ConclusionsOpen lobectomy could achieve better LN dissection efficacy than thoracoscopic lobectomy in the treatment of lung cancer, especially in the N2 LNs dissection. These findings require validation by high-quality, large-scale randomized controlled trials.

A glance at the history of uniportal video-assisted thoracic surgery

“…It is still an open debate whether an equal systematic nodal dissection can be performed via VATS or thoracotomy approach (47). Delgado et al (48) reported better results in uniVATS than in multiport VATS for mediastinal lymphadenectomy.…”

Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer

“…By open approach we were able to palpate the lung, and the rate of detecting additional lung or lymph node metastases may be higher. [25][26][27] However, all metastasectomies were performed by an open operation approach with systematic lymph node dissection, including the surrounding fat tissue.…”

The surgeon thunderbolts in 2016 lung cancer literature

“…Thoracotomy and VATS harvested a similar number of total lymph nodes, mediastinal lymph nodes, and N1 lymph nodes stations. However, the possible existing bias in the original studies, the inter-study heterogeneity, and the inherent limitations of meta-analytic approach require that the findings should be validated in high-quality, large-scale randomised controlled trials (5). Nevertheless, a meta-analysis from Meng et al indicated that lymph node sampling was associated with inferior survival rates in patients with early-stage NSCLC.…”