Thoracotomy Versus Uniportal and Multiportal Video-Assisted Thoracoscopic Approaches for Lymph Node Dissection in Lung Cancer: A Propensity-Matched Analysis

Objective: Video-assisted thoracoscopic surgery (VATS), via multiportal and uniportal approaches, has largely replaced thoracotomy for lung cancer surgery. However, the comparative effectiveness of these techniques in optimal lymph node dissection remains under active investigation. Methods: A retrospective review included 763 patients who underwent lung resection for primary lung cancer between October 2001 and January 2024. Demographic, clinical, and pathological data were collected. Patients were stratified into 3 VATS learning phases: early (2001 to 2016), intermediate (2017 to 2020), and late (2021 to 2024). Propensity score matching (PSM; 1:1) was performed based on age, gender, tumor-node-metastasis staging, and preoperative mediastinal staging status. The number of dissected lymph nodes among groups was compared using the Kruskal–Wallis test. Results: Six hundred patients (78.3%) were male, with a mean age of 61.28 ± 10.18 years. In this cohort, 469 patients (61.2%) underwent thoracotomy, 147 (19.2%) multiportal VATS, and 150 (19.6%) uniportal VATS. The mean number of dissected lymph nodes was 22.1 ± 17.2 for thoracotomy, 16.8 ± 11.1 for multiportal VATS, and 12.8 ± 10.8 for uniportal VATS ( P < 0.001). After PSM, mean lymph node counts were 21.0 ± 18.5, 17.4 ± 11.5, and 13.4 ± 11.1 for thoracotomy, multiportal, and uniportal VATS, respectively ( P < 0.001). In the late phase, thoracotomy had a higher mean lymph node count ( P = 0.006); however, after PSM, differences were not statistically significant ( P = 0.158). Conclusions: Thoracotomy allows more extensive lymphadenectomy in lung cancer patients. However, following the learning curve, multiportal and uniportal VATS approaches may yield comparable outcomes.