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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.
Background:
The American College of Surgeons Commission on Cancer (ACS CoC) has recommended lymph node sampling from 3 mediastinal stations and 1 hilar station, while the European Society of Thoracic Surgeons (ESTS) has recommended a lobe-specific lymph node station sampling strategy for lung cancer resection. Comparative postoperative complications associated with these strategies are unknown. The objective of this study is to evaluate the association of lymph node sampling strategy on postoperative outcomes for lung cancer patients.
Methods:
We conducted a retrospective cohort analysis of elective lung cancer resections from 2018-2023 in a single health system. We performed multivariable Poisson regression with robust variance to evaluate the association of any 30-day postoperative complications and major 30-day postoperative complications across lymph node sampling criteria.
Results:
Of 964 total patients, 524 (54.4%) met ACS CoC, 121 (12.6%) met ESTS, and 428 (44.4%) met neither criteria. Risk-adjusted rates of 30-day postoperative complications were not significantly different between ACS CoC (29.8%), ESTS (27.8%), and neither criteria (34.4%). Risk-adjusted rates of major 30-day postoperative complications were similar between ACS CoC (17.7%) and neither criteria (13.6%) but lower for those meeting ESTS criteria (13.6%, aRR 0.76 95% CI 0.68-0.86).
Conclusions:
There were no risk-adjusted differences in any 30-day postoperative complications between lymph node sampling criteria. These findings suggest that postoperative morbidity associated with lymph node sampling criteria may be less important than considering oncologic outcomes for optimizing quality of lymph node evaluation.
