Quality comparison of mediastinal lymph node dissection between video-assisted thoracic surgery and open thoracotomy: a supplementary analysis of the phase 3 Japan Clinical Oncology Group 1413 trial

Norifumi Tsubokawa; Yasuhiro Tsutani; Tomoyuki Hishida; Hisashi Saji; Masashi Wakabayashi; Makoto Endo; Takahiro Mimae; Tomohiro Miyoshi; Tetsuya Isaka; Mitsuhiro Isaka; Aritoshi Hattori; Hiroshige Yoshioka; Ryu Nakajima; Masaya Yotsukura; Tomohiro Maniwa; Yuta Sekino; Haruhiko Fukuda; Kazuo Nakagawa; Keiju Aokage; Shun-Ichi Watanabe; Morihito Okada

doi:10.1093/ejcts/ezaf206

Quality comparison of mediastinal lymph node dissection between video-assisted thoracic surgery and open thoracotomy: a supplementary analysis of the phase 3 Japan Clinical Oncology Group 1413 trial

Eur J Cardiothorac Surg. 2025 Jun 19:ezaf206. doi: 10.1093/ejcts/ezaf206. Online ahead of print.

Authors

Norifumi Tsubokawa¹, Yasuhiro Tsutani², Tomoyuki Hishida³, Hisashi Saji⁴, Masashi Wakabayashi⁵, Makoto Endo⁶, Takahiro Mimae¹, Tomohiro Miyoshi⁷, Tetsuya Isaka⁸, Mitsuhiro Isaka⁹, Aritoshi Hattori¹⁰, Hiroshige Yoshioka¹¹, Ryu Nakajima¹², Masaya Yotsukura¹³, Tomohiro Maniwa¹⁴, Yuta Sekino⁵, Haruhiko Fukuda⁵, Kazuo Nakagawa¹⁵, Keiju Aokage⁷, Shun-Ichi Watanabe¹³, Morihito Okada¹

Affiliations

¹ Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan.
² Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
³ Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of Chest Surgery, St Marianna University School of Medicine, Kanagawa, Japan.
⁵ JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
⁶ Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
⁷ Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
⁸ Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
⁹ Department of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
¹⁰ Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
¹¹ Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan.
¹² Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan.
¹³ Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
¹⁴ Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
¹⁵ Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.

PMID: 40578313
DOI: 10.1093/ejcts/ezaf206

Abstract

Objectives: This study aimed to compare the quality of mediastinal lymph node dissection (LND) during lobectomy for clinical stage I-II non-small cell lung cancer (NSCLC) between video-assisted thoracic surgery (VATS) and open thoracotomy, using data from the Japan Clinical Oncology Group (JCOG) 1413 phase 3, randomized, controlled trial.

Methods: This analysis draws information from JCOG1413, comparing the efficacy of lobe-specific vs systematic LND with standardised LND protocols. A total of 1,685 patients were included in this exploratory analysis (1,251 VATSs and 434 open thoracotomies). Propensity score matching (PSM) ensured a balanced distribution of patient characteristics. The study's end-point was N2 upstaging, defined as the proportion of upstaging from clinical N0-N1 to pathological N2.

Results: Among 1,685 patients, 141 (8.3%) and 118 (7.0%) had pathological N1 and N2, respectively. The PSM yielded 852 patients (426 per group). The N2 upstaging proportions (7.8% [VATS] vs 7.3% [open], p = 0.795) and the influence of the lobectomy type on N2 upstaging were not significantly different between the two groups. The median number of N2 lymph nodes dissected per defined LND extent was similar (systematic: 13 in both groups, p = 0.236; lobe-specific: 7 in both groups, p = 0.720). Additionally, no significant difference in N2 upstaging was observed between hybrid and complete VATS groups (6.7% in both groups, p =. 982).

Conclusions: This study found no significant differences in N2 upstaging proportions between the VATS and open thoracotomy groups of patients with clinical stage I-II NSCLC. This suggests comparable quality of mediastinal LND in both surgical approaches.This study is a sub-analysis of the JCOG1413 randomized controlled trial. The JCOG1413 trial is registered with the UMIN Clinical Trials Registry (UMIN0000025530).

Keywords: lymph node dissection; non-small cell lung cancer; surgical approach.

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