Efficacy of mediastinal lymph nodes dissection according to surgical access.

Background: Mini-invasive approaches is becoming increasingly prevalent in the surgical management of early-stage lung cancer. However, the oncological advantages of mini-invasive methods remain a subject of debate. This study investigates the efficacy of mediastinal lymphadenectomy through two primary surgical approaches: minimally invasive surgery (MIS) and open Lobectomy (OL). Our objective is to compare the effectiveness of these approaches in achieving thorough lymph node dissection and ensuring accurate staging, ultimately influencing adjuvant therapy decisions and patient outcomes. Method: A prospective analysis was conducted using data from the Department of Thoracic Surgery at San Luigi Gonzaga Hospital, located in Turin, Italy. encompassing a cohort of 143 patients (,45 patients for OL and 98 for MIS) diagnosed with early-stage NSCLC undergoing lobectomy between January 2021 and July 2023 We evaluated several indicators including the mean number of dissected lymph nodes, the number of positive lymph nodes, the percentage of N-upstaged patients, and the presence of residual lymph nodes on the first postoperative CT scan—a novel indicator in the context of such studies. Result: Our results indicate that open thoracotomy retrieves a significantly higher mean number of lymph nodes on the right side compared to MIS (16.76 vs. 12.78, P = 0.032), particularly in the right lower paratracheal station (4R). Similarly, the open approach yielded a higher mean number of positive lymph nodes on the right side (1.60 vs. 0.5217, P = 0.029). The presence of residual lymph nodes post-surgery was not statically significant in the MIS group (8.5%) compared to the open surgery group (22%, P = 0.083). Conclusion: the study showed that the number of the lymph nodes removed during mini-invasive surgery is significantly lower than in open lobectomy group specially on right side. Despite open thoracotomy providing superior anatomical exposure and potentially more extensive lymph node dissection, the findings suggest that MIS, offers adequate nodal staging and oncological outcomes similar to those of open thoracotomy. These results have significant implications for surgical decision-making in NSCLC management. They advocate for a patient-specific approach, leveraging the advantages of MIS where feasible without compromising oncological efficacy. The study underscores the need for enhanced MIS techniques and training to ensure thorough lymphadenectomy. The integration of new indicators, such as residual lymph node evaluation via postoperative CT, offers a valuable addition to the assessment of lymphadenectomy efficacy, contributing to more refined surgical strategies and improved patient outcomes. Keywords: Non-Small Cell Lung Cancer (NSCLC), Lymphadenectomy, Minimally Invasive Surgery, Open Thoracotomy, Lymph Node dissection, Residual Lymph Nodes, Video-Assisted Thoracoscopic Surgery (VATS)