Lymph node dissection in surgery for lung cancer: Comparison of open vs. Video-assisted vs. Robotic-assisted approaches

Abstract

Purpose: We compared open,video-assisted and robotic-assisted thoracoscopic surgical techniques in the dissection of N1 and N2-level lymph nodes during surgery for lung cancer. Methods: This retrospective analysis is based on prospectively collected data of patients (excluding those with N2 or N3 diseases,and sleeve resections) undergoing mediastinal lymph node dissection via open (n = 96),video-assisted thoracoscopy (n = 68),and robotic- assisted thoracoscopy (n = 106). The groups are compared according to the number of lymph node stations dissected,the number of lymph nodes dissected,and the number of lymph nodes dissected by stations. Results: Three techniques had similar results based on the number of the dissected N1 and N2-level lymph node stations. Robotic-assisted thoracoscopic surgery yielded significantly more lymph nodes in total (p = 0.0007),and in the number of dissected N1-level nodes (p <0.0001). All techniques yielded similar number of mediastinal lymph nodes,whereas robotic-assisted thoracic surgery (RATS) yielded more station #11 and #12 lymph nodes compared to the other groups. Conclusions: In this study,robotic-assisted thoracoscopic surgery has been shown to dissect more lymph nodes at N1 level. However,taking the open approach as standard,we could claim that both currently robotic and video-assisted techniques may provide similar number of dissected N1 and N2-level lymph node stations.