Is video-assisted thoracoscopic surgery sufficient for lymph node dissection in pulmonary metastasectomy?

Aim
We evaluated the results of patients undergoing pulmonary metastasectomy with video-assisted thoracoscopic surgery (VATS) and aimed to investigate postoperative lymph node positivity after lymph node dissection (PM-LND).

Material and methods
Patients who underwent pulmonary metastasectomy and mediastinal lymph node dissection with VATS between March 2015 and March 2020 in our clinic were included in the study.

Results
The mean age of 58 patients who underwent pulmonary metastasectomy and mediastinal lymph node dissection with VATS was 56.5. Thirty-four of the patients were female and 24 were male. A total of 61 surgical procedures, 3 of which were bilateral, were performed in 58 patients. The mean number of resected pulmonary metastases was 1.72. The total number of dissected lymph nodes was 191, with an average of 3.1 per surgical procedure. Colon carcinoma (20 patients) and breast carcinoma (16 patients) were the most common primary tumor origin. Others were thyroid, sarcoma, renal cell carcinoma and melanoma. Unexpected lymph node positivity was present in 9 of 58 patients.

Conclusions
Video-assisted thoracoscopic surgery is a technique that can be applied in pulmonary metastasectomy with its advantages such as a low complication rate and rapid recovery. In these patients, lymph node dissection, which is one of the determining factors of prognosis, can be performed effectively with VATS. Mediastinal and hilar lymph node dissection combined with pulmonary metastasectomy is effective in detecting unexpected lymph node positivity.