Matsuura Y, Ichinose J, Nakao M, et al. - Researchers here compared the clinical outcomes of nodal upstaging between video-assisted thoracoscopic surgery (VATS) vs open thoracotomy (OPEN). Performing retrospective evaluation of 1,319 surgically resected lung cancer cases, they identified a total of 193 nodal upstaging cases. Observations revealed equivalent outcomes of nodal upstaging between VATS and OPEN. In the OPEN group, nodal upstaging was more frequent (24%) vs the VATS group (9%), though multivariable analysis showed the surgical approach was not significantly linked with nodal upstaging and, after matching, nodal upstaging with each approach were of equivalent frequency. Nodal upstaging was an independent prognostic factor for worse overall survival, cancer-specific survival, and recurrence-free survival in multivariable analyses. There were no significant variations in recurrence patterns and initial recurrence sites depending on surgical approach. The 5-year post-recurrence survival rate was 52% following VATS and 30% following OPEN; this difference was not statistically significant, nor was the post-recurrence survival rate between the VATS and OPEN groups. Although the frequency of nodal upstaging differed, the difference was not due to inferior quality of lymph node dissection with VATS; rather, it was because of selection bias.