Recommendation-adherent systematic lymph node sampling is not associated with increased complication rates in...

Lymph node harvesting during lung resection procedures is a crucial part of treating lung cancer. Despite medical consensus on this issue, the required and safe extent of lymph node harvesting is under debate. A competing, more conservative approach to nodal harvesting suggests that some patients may benefit from limited sampling (LS), thus avoiding complications related to more extensive nodal dissection. Our goal was to evaluate the complication rates with different lymph node sampling strategies. A retrospective single-center cohort study conducted at a combined cardiothoracic unit (n=521) was formed of patients with non-small cell lung cancer (NSCLC) that underwent lobectomy. Patients were divided into three groups based on the extent of mediastinal nodal sampling: no sampling (NS, n=89), LS (n=313) and recommendation-adherent systematic sampling (RA, n=119). Comparison was made between the three groups. The primary outcome was any postoperative complication. Complication rate was similar between the groups, overall complication 38.2% for NS, 39.6% for LS and 35.3% for RA, P=0.30. Comprehensive complication index (CCI) median 0, interquartile range (IQR) 0-20.9 in all groups, P=0.89. The number of severe complications did not differ at a statistically significant level between the groups, NS 12.4%, LS 11.2% vs. RA 17.6%, P=0.20. Main conclusion was that more extensive lymph node harvesting was not associated with increased complication rates in NSCLC patients who underwent lobectomy.