Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Lymph Node Dissection in Clinical Stage I Lung Cancer: A Meta-Analysis and System Review

Video-assisted thoracoscopic surgery (VATS) is the preferred surgical procedure, causing fewer injuries compared with thoracotomy, but whether VATS can achieve the same lymph node (LN) dissection efficacy is controversial. A systematic literature search was performed to identify studies comparing VATS and thoracotomy in LN dissection for clinical stage I lung cancer. Twenty articles met the inclusion criteria and involved 2,190 patients in the VATS group and 3,000 patients in the open group. Meta-analysis showed that fewer total LNs were dissected in the VATS group, although VATS harvested more left-side LNs. The same number of total LN stations, N2 LNs, N2 LN stations, N1 LNs, and right-side LNs was harvested in both groups. Our findings require further validation in more high-quality, large-scale randomized controlled trials.