Nodal upstaging after surgical intervention was found to be more common following open chest surgery approach to lobectomy for early-stage lung cancer compared with the closed-chest procedure known as video-assisted thoracic surgery (VATS).
VATS is a minimally invasive procedure in which a small camera and surgical instruments are inserted into the patient’s chest through several small incisions. Images of the inside of the chest are then transmitted onto a large video monitor, guiding the surgeon in performing the procedure. The VATS approach is often associated with fewer complications, less pain, improved lung function, shorter recovery periods, and lower acute care costs. Currently, potential differences in lymph node staging are the last remaining barrier to the widespread adoption of VATS lobectomy. Previous studies have suggested that nodal upstaging, or the identification of unsuspected lymph node metastases during the evaluation of surgical specimens, is less common after VATS than after other surgical approaches.
Authors of a study published in the Journal of Thoracic Oncology examined whether there were differences in nodal upstaging between open chest surgery and VATS lobectomy by looking at National Cancer Data Base records of 16,938 lobectomies performed between 2010 and 2011. A total of 4935 (21%) lobectomies were performed using VATS, most commonly at comprehensive community cancer programs. Consistent with previous studies, the researchers found that nodal upstaging was significantly more likely in the 4437 matched patients who underwent open chest surgery than those who underwent VATS (12.8% vs 10.3%). However, the difference among patients who were treated in an academic or research facility was not significant.
Although VATS led to a shorter average length of hospital stay (6.1 days vs 7.4 days) and a lower 30-day mortality rate (1.3% vs 2.1%) than open chest surgery, VATS was more likely to lead to unplanned 30-day readmission (6.9% vs 5.9%).
The authors concluded that, for early-stage lung cancer, the reduced frequency of nodal upstaging after VATS versus open chest surgery varies by the facility type where the procedure was performed, which may indicate that it depends on the level of expertise with minimally invasive surgical procedures like VATS. If this is the case, improved training with the procedure could help to reduce the variability between lobectomy approaches.
