title: Thoracotomy is better than thoracoscopic lobectomy in the lymph node dissection of lung cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  The aim of this study was to investigate which surgical method is better in lymph node (LN) dissection of lung cancer.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Twenty-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).
  
  
  CONCLUSIONS
  Open 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.
authors.affiliation: Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China.
authors.forename: Wenxiong
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China.
authors.forename: Han
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China. yudongliang2015@163.com.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Yu
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008482:Mediastinum / Q000601:surgery; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy
keywords: Lung cancer; Lymph node dissection; Meta-analysis; Thoracotomy; Video-assisted thoracic surgery