Nodal upstaging of early stage lung cancer was more common with open chest surgery for lung lobe removal of early stage lung cancer vs video assisted thoracic surgery (VATS), according to an article published in the Journal of Thoracic Oncology.1

Investigators cautioned that nodal upstaging appeared to be correlated with facility type, “which may be a surrogate for expertise in minimally invasive surgical procedures,” they wrote.

The study examined differences in nodal staging between open and closed (VATS) lobectomy. A total of 16 983 lobectomies of patients with clinical stage T2N0M0 or lower were analyzed, of which 4935 (29.1%) were performed using VATS.

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Results showed that nodal upstaging occurred more frequently in the open group (12.8% vs 10.3%; P < .001). However, in a subgroup of patients who had 7 or more lymph nodes examined, propensity matching showed that nodal upstaging was more common after an open approach when compared with VATS (14.0% vs 12.1%; P = .03).

The authors noted that patients treated in an academic/research experienced no significant difference in nodal upstaging between open and VATS approach.


  1. Medbery RL, Gillespie TW, Liu Y, et al. Nodal upstaging is more common with thoracotomy than with VATS during lobectomy for early-stage lung cancer: an analysis from the National Cancer Data Base [published online ahead of print January 11, 2016]. J Thorac Oncol. doi: 10.1016/j.jtho.2015.10.007.