Video-assisted mediastinal lymphadenectomy in the treatment strategy of patients with non-small cell lung cancer

Lung cancer is leading in death reasons among oncological diseases. Accurate mediastinal staging of the disease influences not only the prognosis of the disease, but also the strategy of complex antitumor treatment. Objective. To evaluate the clinical effectiveness of mediastinal staging using video-assisted mediastinal lymphadenectomy (VAMLA) in treatment planning for patients with resectable forms of non-small cell lung cancer. Material and methods. From august 2020 to March 2025 results and clinical efficiency of VAMLA were analyzed. 110 patients were included. The median age was 66 years, there was a male preponderance (90:20). Central cancer was detected in 33 (32.4%) patients. More than half of the patients (62.7%) had squamous cell cancer. Results. The median number of resected lymph nodes was 19. In 110 patients, 58 (52.7%) were restaged. 46 (41.8%) patients were down-staged, 12 (10.9%) patients were up-staged. False-positive results of PET-CT were diagnosed on 45.4% of patients, whom PET-CT was performed. False-negative results were diagnosed in 1.8% of these cases. After invasive staging, in 63 (57.2%) cases radical lung surgery was performed. 43 (39.1%) patients were treated by chemo-immunotherapy, in which 30 patients has already undergone radical surgery. Conclusion. VAMLA has the highest diagnostic accuracy among staging techniques, minimizing the rate of false-negative results and excluding multizonal N2 lymph node involvement. Optimizing indications for invasive mediastinal staging, considering individual risk factors, disease prognosis, and multimodal treatment strategies, requires further research and may eventually reduce unnecessary staging procedures. Indications for invasive staging should be based on a multidisciplinary team decision.