ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2020
The association of nodal upstaging with surgical approach and its impact on long-term survival after resection of non-small-cell lung cancer.
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
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29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Robotic-assisted versus video-assisted thoracoscopic anatomical lung resection for early-stage non-small cell lung cancer: a systematic review and meta-analysis.Journal of robotic surgery · 2026Pooled it
- Pooled it
- Impact of modern minimally invasive approaches on pulmonary resection outcomes: a narrative review.Journal of thoracic disease · 2026Review
- Current state of evidence for RATS lobectomy for NSCLC.Journal of cardiothoracic surgery · 2026Review
- Benchmarking Large Language Models Using a Best Evidence Topic Report in a Patient With Early Non-Small Cell Lung Cancer.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
- Evaluation of lymph nodes in various surgical approaches for clinical N0 lung cancer: a systematic review and network meta-analysis.International journal of surgery (London, England) · 2026Article
- Clinical characteristics of post-operative N2 nodal upstaging in non-small cell lung cancer: a retrospective cohort study.Translational lung cancer research · 2025Article
- Robotic-Assisted Thoracoscopic Surgery Versus Video-Assisted Thoracoscopic Surgery: Which Is the Preferred Approach for Early-Stage NSCLC?Journal of clinical medicine · 2025Review
- Propensity score matched comparison of lymph node upstaging in early-stage lung cancer: open versus minimally invasive surgery with standardized lymphadenectomy.Journal of cardiothoracic surgery · 2025Article
- Transitioning from video-assisted to robotic-assisted anatomical pulmonary resection: outcomes from 340 cases in an Australian centre.Frontiers in oncology · 2025Article
- Improving quality outcomes via process improvements and innovation: the largest single-surgeon series of 1,701 consecutive robotic lobectomy and segmentectomy cases.Frontiers in surgery · 2025Article
- Long-term outcomes of robotic versus video-assisted pulmonary lobectomy for non-small cell lung cancer: systematic review and meta-analysis of reconstructed patient data.Journal of thoracic disease · 2023Article
- Review
- Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management-State of the Art.Cancers · 2023Review
- A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy.Cancers · 2023Article
- Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis.Cancers · 2023Article
- Article
- Short-term outcomes of robot-assisted versus video-assisted thoracoscopic surgery for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a single-center retrospective study.Frontiers in immunology · 2023Article
- Management of middle lobe veins during single-portal video-assisted thoracoscopic surgery lobectomy via the fifth intercostal approach (case series): why the subcarinal triangular right base angle is helpful.Journal of thoracic disease · 2022Article
- Comment on "The Unbearable Lightness of Difference Between Statistical and Clinical Significance".Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2022Article
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5 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesProponents of open thoracotomy (OPEN) and robot-assisted thoracic surgery (RATS) claim its oncological superiority over video-assisted thoracic surgery (VATS) in terms of the accuracy of lymph node staging.
methodsThe National Cancer Database was queried for patients with non-small-cell lung cancer (NSCLC) undergoing lobectomy without neoadjuvant therapy from 2010 to 2014. Nodal upstaging rates were compared using a surgical approach. Overall survival adjusted for confounding variables was examined using the Cox proportional hazards model.
resultsA total of 64 676 patients fulfilled the selection criteria. The number of patients who underwent lobectomy by RATS, VATS and OPEN approaches was 5470 (8.5%), 17 545 (27.1%) and 41 661 (64.4%), respectively. The mean number of lymph nodes examined for each of these approaches was 10.9, 11.3 and 10 (P < 0.01) and upstaging rates were 11.2%, 11.7% and 12.6% (P < 0.01), respectively. For patients with clinical stage I disease (N = 46 826; RATS = 4338, VATS = 13 416 and OPEN = 29 072), the mean lymph nodes examined were 10.6, 10.8 and 9.4 (P < 0.01), and upstaging rates were 10.8%, 11.1% and 12.1% (P < 0.01), respectively. A multivariable analysis suggested an association with improved survival with RATS and VATS compared with OPEN surgery [hazard ratio (HR) = 0.89 and 0.89, respectively; P < 0.01] for patients with all stages. In stage I disease, VATS but not RATS was associated with increased overall survival compared with the OPEN approach (HR = 0.81; P < 0.01).
conclusionsRATS lobectomy is not superior to VATS lobectomy with respect to lymph node yield or upstaging of NSCLC. Increased nodal upstaging by the OPEN approach does not confer a survival advantage in any stage of NSCLC and may be associated with decreased overall survival.
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