Evaluation of lymph nodes in various surgical approaches for clinical N0 lung cancer: a systematic review and network meta-analysis

In terms of nodal upstaging incidence for cN0-pN1 and cN0-pN2, both OPEN and RATS performed well. For N1 lymph node (LN) resection, the OPEN approach is superior to the RATS and VATS approaches, whereas for N2, the RATS approach is superior to the OPEN and VATS approaches. Regarding the total number of LNs removed, the video-assisted mediastinoscopic lymphadenectomy (VM) + VATS and OPEN have obvious advantages. The publication year, sample size, and surgical area affected the incidence of cN0-pN2 and the total number of LNs removed. These findings may help thoracic surgeons to select different surgical approaches for patients with clinical N0 lung cancer and different tendencies for LN metastasis.