title: Lymph node evaluation achieved by open lobectomy compared with thoracoscopic lobectomy for N0 lung cancer.
abstract: BACKGROUND
  Controversy remains regarding the adequacy of the lymph node evaluation achieved by video-assisted thoracic surgery (VATS) lobectomy for lung cancer. This study compared the completeness of the lymph node dissection or sampling for patients undergoing lobectomy by open thoracotomy vs VATS for clinical N0 lung cancer.
  
  
  METHODS
  This study was a retrospective review of 129 patients who underwent lobectomy for clinical N0 lung carcinoma from December 2008 to January 2012.
  
  
  RESULTS
  Lobectomy was an open procedure in 69 patients (53.5%) and by VATS in 60 (46.5%). The VATS and open groups were well matched for age (p = 0.50) and forced expiratory volume in 1 second percentage predicted (p = 0.16). The mean pathologic tumor sizes were not significantly different (2.9 ± 0.26 vs 3.4 ± 0.25 cm, respectively; p = 0. 14). The mean number of nodes dissected in the open group was significantly higher (14.7 ± 1.3 vs. 9.9 ± 0.8 nodes; p = 0.003). In the open lobectomy group, 24.6% of the patients were upstaged to pathologic N1 or N2 compared with 10% in the VATS group (p = 0.05). The Kaplan-Meier 3-year survival was similar between the groups.
  
  
  CONCLUSIONS
  In our hands, significantly more lymph nodes were dissected, and a higher percentage of patients were upstaged to N1/N2, during open lobectomy compared with VATS lobectomy in patients with clinical stage N0 lung cancer. Although this did not translate into improved survival at 3 years, concern is raised about the adequacy of lymph node dissection during VATS lobectomy.
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California. Electronic address: rmerritt@stanford.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Merritt
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California; Department of Surgery, VA Palo Alto Health Care System, Stanford, California.
authors.forename: Chuong D
authors.initials: CD
authors.lastname: Hoang
authors.affiliation: Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California; Department of Surgery, VA Palo Alto Health Care System, Stanford, California.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy
keywords: 10; ACSOG; American College of Surgeons Oncology Group; CAD; COPD; CT; FEV(1); NSCLC; PET; SD; VATS; chronic obstructive pulmonary disease; computed tomography; coronary artery disease; forced expiratory volume in 1 second; non-small cell lung cancer; positron emission tomography; standard deviation; video-assisted thoracoscopic surgery