SO07P
COMPARING VATS AND OPEN MEDIASTINAL LYMPH NODE DISSECTION ACCORDING TO THE PROPOSED NODAL ZONES OF THE IASLC STAGING COMMITEE

Background:   Radical lobectomy for early‐stage Non‐Small Cell Lung Cancer (NSCLC) by way of Video‐assisted Thoracic Surgery (VATS) is a safe procedure with reduced post‐operative morbidity. It has yet to gain world wide acceptance due to a perceived oncological inadequacy. Mediastinal Lymph Node Dissection (MLND) has a confirmed 4‐year survival advantage over lymph node (LN) sampling (HR 0.78; 95% CI: 0.63–0.93). We aim to compare the quality of MLND samples from VATS and Open lobectomies.Methods:   VATS lobectomies were compared with open lobectomy controls from 2000 to 2008. Retrospective pathology reviews were performed on all MLND samples. LN was counted according to each IASLC nodal zones. The number of LN per zone and in total was compared. Anatomical location of the lobectomy and the 7th ed. cTNM stage was recorded.Results:   We included 132 VATS and 157 Ospen lobectomies (132:157). Stage distribution for VATS and Open were: Stage IA (64:55), State IB (64:68), Stage IIA (3:17), Stage IIB (1:14), Stage IIIA (0:3). Mean tumour diameter was 26 mm and 37 mm for VATS and Open respectively. Anatomical location of lobectomies for VATS and Open were: Right (91:100), Left (49:64). The mean number of LN dissected by VATS was higher in the upper mediastinal (Mean 7.2 vs. 4.0; p < 0.05), aorto‐pulmonary (Mean 3.0 vs. 2.6), subcarinal (3.0 vs. 2.4), and hilar/interlobar zones (2.0 vs. 1.8). In total, VATS averaged 23 LN per case compared with 18 for Open (p < 0.05). Open lobe MLND performed better for the lower mediastinal zone.Conclusion:   The quality of VATS MLND is often better than that of a thoracotomy, and therefore an adequate oncological procedure for early‐stage NSCLC with reduced post‐operative morbidity.