Video-assisted thoracic surgery lobectomy for unexpected pathologic N2 non-small cell lung cancer

Background: This study was performed to assess early and late outcomes of pathologic N2 disease unexpectedly detected in patients with non-small cell lung cancer undergoing video-assisted thoracic surgery (VATS) lobectomy for clinical stage I. Methods: We retrospectively reviewed the clinical features of patients with unexpected N2 non-small cell lung cancer and their early and late outcomes in the VATS lobectomy group versus the open thoracotomy lobectomy group. Results: The overall survival time for all 358 patients was 33.26 +/- 0.90 months. The overall survival time for 117 cases in the VATS lobectomy group was 36.02 +/- 1.44 months. The overall survival time for 241 cases in the open thoracotomy lobectomy group was 31.92 +/- 1.14 months. The survival rates for patients in the VATS lobectomy group were 92.31%, 36.75%, 5.13% at one, three, and five years, respectively. The survival rates for patients in the open thoracotomy lobectomy group were 92.12%, 21.58%, 2.49% at one, three, and five years, respectively. A significant difference was found between the two groups regarding this factor ((X) over bar (2) = 3.88, P = 0.049). Conclusions: VATS lobectomy is feasible and safe to perform on patients with minimal N2 non-small cell lung cancer. Even if lymph node metastasis is unexpectedly detected during surgery, with rigorous preoperative evaluation and systematic lymph node dissection, there is no need to convert to open thoracotomy lobectomy.