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Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches

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Abstract

Background

Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations.

Methods

A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting.

Results

A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020).

Conclusions

The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52, Ostrava, Czech Republic

    Lubomír Tulinský, Markéta Kepičová, Peter Ihnát, Marcel Mitták & Lubomír Martínek

  2. Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic

    Lubomír Tulinský, Markéta Kepičová, Peter Ihnát, Marcel Mitták & Lubomír Martínek

  3. Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic

    Hana Tomášková

  4. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852, Ostrava, Czech Republic

    Lucia Staníková

  5. Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic

    Lucia Staníková

  6. Department of Forensic Medicine, University Hospital Ostrava, 17. Listopadu 1790, 708 52, Ostrava, Czech Republic

    Lucia Ihnát Rudinská

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  1. Lubomír Tulinský
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Correspondence to Lucia Ihnát Rudinská.

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Lubomír Tulinský, Markéta Kepičová, Peter Ihnát, Hana Tomášková, Marcel Mitták, Lucia Staníková, Lubomír Martínek and Lucia Ihnát Rudinská have no conflicts of interest or financial ties to disclose.

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Tulinský, L., Kepičová, M., Ihnát, P. et al. Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches. Surg Endosc 37, 9208–9216 (2023). https://doi.org/10.1007/s00464-023-10476-1

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