Comparing Nodal Upstaging Rates and Morbidity and Mortality of Common Nodal Sampling Guidelines in the STS General...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Nodal Staging

Background:

• Accurate lymph node staging is crucial for non-small cell lung cancer (NSCLC) treatment and prognosis.
• Current nodal sampling guidelines vary, impacting clinical practice and patient outcomes.

Purpose of the Study:

• To compare nodal upstaging and morbidity and mortality (M&M) rates for Operative Standard 5.8 against other established and hypothetical nodal sampling guidelines.
• To assess the impact of adherence to specific nodal sampling guidelines on patient outcomes in NSCLC resections.

Main Methods:

• Retrospective analysis of 46,954 patients with clinical stage I-IIIA NSCLC who underwent resection, identified from the Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD).
• Evaluation of nodal upstaging and M&M rates for Operative Standard 5.8, modified European Society for Thoracic Surgery (ESTS), modified Japanese, and a "2+1" guideline, compared to patients meeting no guideline.
• Multivariable logistic regression was used to compare odds of nodal upstaging and M&M between guideline groups.

Main Results:

• A significant proportion of patients met the evaluated guidelines: Operative Standard 5.8 (68.7%), modified ESTS (32.4%), modified Japanese (25.9%), and "2+1" (83.9%).
• Nodal upstaging rates were consistently higher for patients meeting any guideline (11.5-11.7%) compared to those meeting no guideline (7.6%).
• Morbidity and mortality (M&M) rates were nearly identical across all four guidelines (5.2-5.3%) and comparable to the no-guideline group (4.9%).

Conclusions:

• Operative Standard 5.8, modified ESTS, modified Japanese, and "2+1" nodal sampling guidelines demonstrate comparable performance in terms of nodal upstaging and M&M rates.
• Adherence to any nodal sampling guideline is associated with higher rates of nodal upstaging compared to not meeting any guideline.
• These findings support the similar efficacy of various nodal sampling strategies in NSCLC surgery.