Computed tomography and positron emission tomography-staged cN0 non-small cell lung cancer

Background: Little is known about the relative superiority of existing lobectomy approaches. We retrospectively summarized the clinical outcomes of four-port (i.e., multiple-port) thoracoscopic surgery (TS) lobectomy with lymph node dissection (LND) in patients with stage cN0 non-small cell lung cancer (NSCLC). Methods: This retrospective study included 245 patients (119 men and 126 women; median age, 65 years) with stage cN0 NSCLC according to both computed tomography (CT) and positron emission tomography (PET) scans. Two patients (0.8%) who underwent thoracotomy conversion were excluded. Regarding prognostic implications, disease-free survival (DFS) and overall survival (OS) outcomes were analyzed according to the mediastinal size (MD) category using the Kaplan-Meier method. Results: Overall, 10 cases (4.1%) of mediastinal nodal upstaging (cN0pN2) and 9 (3.7%) cases of hilar or peribronchial nodal upstaging (cN0pN1) were observed. The 5-year DFS and OS rates after TS lobectomy with LND were 90.5% and 97.9%, respectively. In a subgroup analysis by MD, a significant difference in DFS was only observed between the groups with a MD ≤5 mm and 1 mm (P=0.04). No significant differences in OS were observed between the subgroups. Conclusions: The clinical outcomes after TS lobectomy via the four-port, upside-down monitor approach appears to contribute to a favorable prognosis. However, MD was not identified as an independent prognostic factor for survival in patients with stage cN0 NSCLC.