Video-assisted mediastinoscopic lymphadenectomy combined with minimally invasive pulmonary resection for left-sided lung cancer: feasibility and clinical impacts on surgical outcomes†.

OBJECTIVES: Although video-assisted mediastinoscopic lymphadenectomy (VAMLA) has greatly increased the accuracy of mediastinal staging, its clinical value as a therapeutic tool for complete mediastinal lymph node dissection in the treatment of left-sided lung cancer is not well elucidated.

METHODS: We identified the consecutive 649 patients with left-sided lung cancer undergoing minimally invasive pulmonary resection between July 2002 and June 2013. Among them, 225 patients underwent VAMLA combined with pulmonary resection (VAMLA + VATS group), while the remaining 424 patients underwent VATS procedure only (VATS group). Operative outcomes including procedural time, removed lymph nodes and node stations, complications and the final pathological mediastinal staging in the both groups were evaluated and compared.

RESULTS: There was no significant difference in the baseline profiles between the two groups. The patients in the VATS + VAMLA group showed significantly shorter operative time (116.8 ± 39.8 vs 159.8 ± 44 .0 min; P < 0.001), more extensive lymph node dissection (total number of removed lymph nodes, 29.7 ± 10.8 vs 23.0 ± 8.6; P < 0.001) and the higher rates of patients with mediastinal lymph nodes removed: Station 2 on the right (12.4 vs 0.2%), Station 2 on the left (15.1 vs 0.2%), Station 4 on the right (42.7 vs 0.9%), Station 4 on the left (87.6 vs 57.3%) and Station 7 (100 vs 99.3%), while maintaining comparable surgical morbidities compared with the VATS group. Also, the patients in the VATS + VAMLA group tended to have higher rates of being upstaged with mediastinal involvement (8.0 vs 5.7%; P = 0.31).

CONCLUSIONS: VAMLA is a clinically feasible procedure safely performed as a therapeutic tool for complete mediastinal lymph node dissection (MLND), and can be a good complement to minimally invasive pulmonary resection in left-sided lung cancer, where optimal MLND is not always feasible with VATS approach. Further studies are required to investigate the long-term clinical impacts of VAMLA with regard to survival and tumour recurrence.