A systemic review was performed to investigate whether video-assisted thoracic surgery (VATS) could achieve equivalent lymph node (LN) evaluation efficacy to thoracotomy. A comprehensive search of PubMed, EMBASE, and Cochrane was performed to identify studies comparing VATS and thoracotomy in LNs and node stations. Mean difference was calculated by Review Manager 5.0 software and Stata 12. Twenty-four studies met the inclusion criteria of LN evaluation. 2,015 patients were involved in VATS group in contrast to 3,250 patients in thoracotomy group. The same number of total nodes stations (mean difference, 0.09; 95 % CI -0.25 to 0.42; P = 0.61) and mediastinal node stations (mean difference, -0.11; 95 % CI -0.24 to 0.01; P = 0.08) could be assessed by thoracotomy and VATS. The same number of N1 LNs (mean difference, -0.33; 95 % CI -0.70 to 0.05; P = 0.09) could be assessed by both groups. While more total (mean difference, -1.41; 95 % CI -1.99 to -0.83; P < 0.00001) and mediastinal LNs (mean difference, -1.03; 95 % CI -1.81 to -0.24; P = 0.01) could be harvested by thoracotomy. Outcome showed that the same number of total and mediastinal LN stations could be harvested by VATS and OT. The same number of N1 LNs could be harvested by VATS and OT, while less total and mediastinal LNs could be harvested by VATS.