Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry

Alessandro Bertani, Alessandro Gonfiotti, Mario Nosotti, Paolo Albino Ferrari, Lavinia De Monte, Emanuele Russo, Gioacchino Di Paola, Piero Solli, Andrea Droghetti, Luca Bertolaccini, Roberto Crisci, Carlo Curcio, Dario Amore, Giuseppe Marulli, Samuele Nicotra, Andrea De Negri, Paola Maineri, Gaetano di Rienzo, Camillo Lopez, Angelo MorelliFrancesco Londero, Lorenzo Spaggiari, Roberto Gasparri, Guido Baietto, Caterina Casadio, Maurizio Infante, Cristiano Benato, Marco Alloisio, Edoardo Bottoni, Giuseppe Cardillo, Francesco Carleo, Franco Stella, Giampiero Dolci, Francesco Puma, Damiano Vinci, Giorgio Cavallesco, Pio Maniscalco, Luca Ampollini, Paolo Carbognani, Alberto Terzi, Andrea Viti, Giampiero Negri, Alessandro Bandiera, Reinhold Perkmann, Francesco Zaraca, Claudio Andretti, Camilla Poggi, Felice Mucilli, Pierpaolo Camplese, Alessandro Stefani, Italian VATS Group

Research output: Contribution to journalArticlepeer-review


Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

Original languageEnglish
Pages (from-to)2061-2070
Number of pages10
JournalJournal of Thoracic Disease
Issue number7
Publication statusPublished - Jul 1 2017


  • Lymph node (LN)
  • Nodal upstaging
  • VATS lobectomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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