In a study published in the Journal of Thoracic Oncology, researchers found an increase in the stage of non-small cell lung cancer due to cancer positive lymph node discovery was more common following open chest surgery for lung lobe removal of early stage lung cancer compared to the closed chest procedure known as video assisted thoracic surgery.
The National Cancer Data Base was examined for NSCLC patients who underwent lobectomy between 2010 and 2011 for tumors smaller than 7 cm and no apparent LN involvement prior to surgery. Statistical analyses were performed to compare nodal upstaging in VATS compared to open thoracotomies and to determine if there were difference depending on the surgical center.
Here are five key points:
1. A total of 16,983 lobectomies were performed, and 29.1 percent of those used VATS.
2. Of all 4,935 VATS, 4.9 percent were performed at community centers, 50 percent at comprehensive community cancer programs and 45.1 percent at academic or research centers.
3. Upstaging because of the discovery of cancer in LN during surgery was more frequent in the open vs. closed group (12.8 percent vs. 10.3 percent) even though a greater number of LNs were sampled using VATS.
4. The open approach resulted in longer length of hospital stay with a mean of 7.4 vs. 6.1 days, and a higher 30-day mortality rate (2.1 percent vs. 1.3 percent), whereas VATS was more likely to lead to an unplanned 30-day readmission (6.9 percent vs. 5.9 percent).
5. For patients who were treated in an academic or research facility, the difference in nodal upstaging for open lobectomy vs. VATS was no longer statistically significant but was numerically higher (12.2 percent vs. 10.5 percent).