Lymph Node Dissection and Postoperative Complications After Lung Cancer Resection.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Current lung cancer guidelines recommend the 3+1 rule for lymph node sampling (LNS), involving at least 3 mediastinal (N2) and 1 hilar (N1) nodal stations.
• While rigorous LNS offers oncologic benefits, its impact on surgical outcomes requires thorough investigation as its adoption increases.

Purpose of the Study:

• To determine if adherence to the 3+1 lymph node sampling rule is associated with a higher rate of postoperative complications in non-small cell lung cancer (NSCLC) patients.

Main Methods:

• A retrospective cohort study analyzed data from the Society of Thoracic Surgeons General Thoracic Database (July 2021-January 2023).
• Patients with clinical stage T1-T3, N0, M0 NSCLC undergoing resection with known LNS were included.
• Propensity matching was used to compare postoperative complication rates between patients who did and did not satisfy the 3+1 rule.

Main Results:

• The study included 28,439 NSCLC patients; 66.6% met the 3+1 rule criteria.
• Unadjusted analysis showed longer operating times and higher rates of pathologic upstaging in the 3+1 group.
• Post-propensity matching analysis revealed no significant differences in postoperative complication rates between the groups.

Conclusions:

• Adherence to the 3+1 lymph node sampling rule in NSCLC surgery is not associated with increased postoperative complications.
• These findings support the safety of the 3+1 rule, encouraging its continued use as guideline-concordant care.