A narrative review on lymphadenectomy: from open to minimally invasive surgery

Objective: One of the most debated topics is minimally invasive lymphadenectomy's safety and quality, in terms of number of lymph-nodes (LNs) dissected, number of mediastinal stations explored and nodal migration rate. With this narrative review, we retraced the history of lymphadenectomy for lung cancer by comparing the main features of open and minimally invasive techniques [video-assisted thoracic surgery (VATS) and robotic surgery].Background: Lymphadenectomy plays a crucial role during surgical treatment for lung cancer and represents a cornerstone to assess staging and prognosis, since LN involvement is an important factor to define post-operative strategies and to predict oncological outcomes. Nevertheless, unanimous agreement on the extent and the technique of lymphadenectomy is still far from being achieved and even the major societies of Thoracic Surgery and Oncology, proposed different strategies, advice or guidelines on this issue.Methods: We conducted a PubMed search for relevant literature on lymphadenectomy for non-small cell lung cancer (NSCLC), selecting only those reporting information about feasibility and effectiveness of the various surgical techniques and approaches.Conclusions: To date, data seem support the value of lymphadenectomy by minimally invasive approaches since outcomes in terms of safety, feasibility, and effectiveness; especially in the treatment of early-stage NSCLC were comparable to those of the open approach.The future discussion about the "perfect lymphadenectomy" will be focused more on other debated arguments that the surgical approach, like the amount of LN material collected (en bloc LN or nodal fragments), the most suitable stations to analyse according to the type of intervention or disease's site, and less about comparing the effectiveness of different surgical approaches.