Approaches to Mediastinal Staging in NSCLC Among Thoracic Surgeons: A Survey Study From Türkiye

Mediastinal lymph node staging is a critical step in the treatment algorithm for non-small cell lung cancer (NSCLC). Current guidelines define the patient groups in which invasive or minimally invasive mediastinal lymph node sampling is required during preoperative staging. This study aimed to determine the extent to which thoracic surgeons actively practicing in Türkiye adhere to these guideline recommendations and to assess the concordance between their daily clinical practices and these recommendations.

A guideline-based survey, including nine case scenarios, was emailed to 417 thoracic surgeons registered with the Turkish Thoracic Surgery Association. The survey collected data on participants' demographic characteristics, institutional profiles, and approaches to each clinical scenario. Responses were analyzed for concordance with guideline recommendations.

The survey response rate was 29.2% (n=122). A total of 48.3% of the participants possessed an academic title, and 77.8% were employed at training and research or university hospitals. In scenarios involving a radiologically positive, single, non-bulky N2 lymph node, 85.2% of respondents indicated that invasive mediastinal staging was required by guidelines. In contrast, among patients without radiologic evidence of N2 disease, the proportion of surgeons recommending mediastinal staging was 19.7% for squamous cell carcinoma >3 cm in size and 36.9% for adenocarcinoma. For centrally located tumors, 59% of participants recommended staging. Notably, there was substantial variation in opinions regarding the necessity of invasive sampling for suspicious aortopulmonary window lymph nodes.

Thoracic surgeons in Türkiye generally exhibit approaches to mediastinal staging that align with guideline recommendations; however, variations exist in certain subgroups. Standardization is particularly needed in the definition of central tumors, the approach to sampling aortopulmonary lymph node stations, and staging strategies based on histologic tumor type. These findings highlight the importance of educational and awareness initiatives aimed at improving the integration of guideline recommendations into clinical practice.