Provider and procedural factors associated with guideline-concordant lymph node sampling in lung cancer resection

The American College of Surgeons Commission on Cancer Standard 5.8 requires sampling of 3 mediastinal and 1 hilar lymph node stations during lung cancer resection. This study explores provider and procedural factors associated with guideline-concordant lymph node sampling during lung cancer resection.

Prospectively collected statewide quality collaborative data were queried for adult patients undergoing lung cancer resection between July 1, 2021, and June 30, 2024. Guideline concordance was defined per American College of Surgeons Commission on Cancer Standard 5.8. Multivariable logistic regression was used to assess the likelihood of guideline-concordant sampling across surgeon volume, practice distribution, resection type, and procedural approach. Rates of nodal upstaging and postoperative complications were compared between guideline-concordant and nonconcordant sampling cohorts.

A total of 3031 patients were analyzed. Of 43 surgeons, 26 were general thoracic surgeons and 17 were mixed-practice cardiothoracic surgeons. 77.8% of cases demonstrated guideline-concordant sampling. Patients treated by highest-volume surgeons were more likely to receive concordant sampling than patients treated by lowest-volume surgeons (odds ratio, 2.27 [1.03-5.01], P = .042) with no significant difference between general thoracic surgeons and cardiothoracic surgeons. Patients undergoing wedge resection were less likely to receive concordant sampling (odds ratio, 0.17 [0.13-0.23], P < .001), as were patients undergoing open (odds ratio, 0.46 [0.33-0.66], P < .001) or video-assisted thoracic surgery (odds ratio, 0.35 [0.25-0.48], P < .001) resection compared with robotic resection. No differences in nodal upstaging or complications were found between the guideline-concordant and nonconcordant cohorts.

Guideline-concordant lymph node sampling is associated with surgeon volume, resection type, and operative approach. These findings inform initiatives to improve performance in lymph node sampling during lung cancer resection.