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David S. Ettinger, MD, FACP, FCCP


STS 2022: Surgical Approaches to Lobectomy for NSCLC: Lymph Node Upstaging and Overall Survival

By: Vanessa A. Carter, BS
Posted: Monday, January 31, 2022

During the 2022 Annual Meeting of The Society of Thoracic Surgeons (STS), Robert E. Merritt, MD, of The Ohio State University, Columbus, and colleagues presented their study on lymph node upstaging rates for thoracoscopic, robotic, and open lobectomies in patients with stage T2 to 3N0 non–small cell lung cancer (NSCLC). Although these investigators found no significant difference in N1 and N2 lymph node upstaging rates among surgery types, they did observe a significantly higher 5-year overall survival rate with thoracoscopic and robotic lobectomies.

This retrospective study collected data on 24,257 patients with clinical stage T2 to 3N0 NSCLC from the National Cancer Database. The rate of N1 and N2 staging as well as the median number of lymph nodes removed were recorded for thoracoscopic, robotic, and open lobectomy approaches. A Cox multivariate model was performed, and the 5-year Kaplan-Meier survival rates were determined for each surgical approach.

The majority (n = 15,825) of patients underwent open lobectomy, followed by thoracoscopic (n = 6,004) and robotic (n = 2,418) lobectomies. Both the cohorts of thoracoscopic and robotic lobectomies had a median of 11 lymph nodes removed, compared with the open lobectomy cohort (median of 9 lymph nodes removed; P < .0001).

The N1 upstaging rate was slightly higher with open lobectomy (12%) than with thoracoscopic or robotic lobectomy (11%), although the difference was not statistically significant. The N2 upstaging rate was also higher with open lobectomy (6%) but again was not significant when compared with thoracoscopic or robotic lobectomy (5%).

The 5-year Kaplan-Meier survival rate was significantly lower with open lobectomy (57.1%) compared with robotic (61.8%) or thoracoscopic (65.2%) lobectomy (P < .001). Of note, the Cox multivariate model identified both age at diagnosis (P < .001) and the open lobectomy approach (P < .001) as strong indicators of a worse overall survival.

Disclosure: For disclosures of the study authors, visit

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