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Association of Postoperative Complication and Lymph Node Sampling Criteria in Lung Cancer Resection
Ryan C Jacobs1, Maxime A Visa1, Austin B Chang1
1Canning Thoracic Institute, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Journal of the American College of Surgeons
|September 11, 2025
Summary
Lung cancer lymph node sampling strategies by ACS CoC and ESTS showed no difference in overall postoperative complications. However, the ESTS strategy was associated with fewer major complications, suggesting oncologic outcomes may be more critical than morbidity for evaluation quality.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Current guidelines for lung cancer lymph node sampling differ between the American College of Surgeons Commission on Cancer (ACS CoC) and the European Society of Thoracic Surgeons (ESTS).
- The comparative impact of these distinct lymph node sampling strategies on postoperative complications remains largely unexamined.
Purpose of the Study:
- To investigate the association between different lymph node sampling strategies (ACS CoC vs. ESTS vs. neither) and postoperative outcomes in lung cancer patients.
- To evaluate the impact of lymph node sampling criteria on 30-day postoperative complications, including major complications.
Main Methods:
- A retrospective cohort analysis of 964 patients undergoing elective lung cancer resections between 2018 and 2023.
- Multivariable Poisson regression with robust variance was employed to compare 30-day postoperative complication rates across the defined lymph node sampling criteria.
Main Results:
- No significant difference in overall 30-day postoperative complications was observed between patients meeting ACS CoC criteria (29.8%), ESTS criteria (27.8%), or neither (34.4%).
- Patients adhering to ESTS criteria exhibited a lower risk-adjusted rate of major 30-day postoperative complications (13.6%) compared to those meeting neither criteria (aRR 0.76, 95% CI 0.68-0.86).
- Rates of major complications were similar between ACS CoC (17.7%) and neither criteria (13.6%) groups.
Conclusions:
- Lymph node sampling strategies, including ACS CoC and ESTS guidelines, did not demonstrate significant differences in overall 30-day postoperative morbidity.
- The ESTS-specific strategy may be associated with a reduced risk of major postoperative complications.
- These findings suggest that prioritizing oncologic outcomes over postoperative morbidity may be crucial for optimizing the quality of lymph node evaluation in lung cancer surgery.
