VATS mediastinal lymph node dissection: surgical technique and literature review

Objective: With this review we have aimed to present our video-assisted thoracoscopic surgery mediastinal lymph node dissection (VATS MLND) technique and to discuss about its accuracy. Background: VATS resections (lobectomy) have proved to reach the same oncologic outcomes than thoracotomy ones for stage I non-small cell lung cancer. It is also shown that VATS MLND is not inferior to open thoracotomy in terms of accuracy of mediastinal lymph node dissection. Methods: From May 2012 to December 2020, 525 patients were operated of VATS lobectomy with a multiportal approach for non-small cell lung cancer (NSCLC) (468 stage I and 57 stage II-IV) at a high volume Italian Thoracic Surgery Unit: 42 procedures with a 4-port approach, 56 procedures with a 3-ports approach and 427 with a 2-port approach. The main post-operative complications are reported. We described the VATS MLND technique separately as right and left MLND to point out the technical peculiarities of each node station starting with the anatomy. The accuracy of the procedure presented is analyzed in terms of number of lymph node retrieved and upstaging rate comparing our data with that of the most authoritative literature on this topic. We also investigated for the presence of predictors of postoperative complications. Conclusions: We should learn further to became more skilled at performing an adequate VATS lymph node dissection. According to the data presented we can conclude that VATS MLND is a safe and accurate procedure.