ArticleJournal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer2022
Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in Early Stage NSCLC.
Article in Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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35 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- Robotic-assisted thoracic surgery versus video-assisted thoracic surgery for patients undergoing lung resection: a systematic review and meta-analysis of randomized controlled trials.General thoracic and cardiovascular surgery · 2026Pooled it
- Efficacy of Adjuvant Chemoimmunotherapy versus Chemotherapy and the Impact of Lymph Node Dissection on Survival.Annals of surgical oncology · 2026Article
- Extent of Endobronchial Ultrasound Nodal Sampling and Risk of Pathologic N2 Upstaging in Clinical N0-N1 Non-Small Cell Lung Cancer.Thoracic cancer · 2026Article
- Survival benefit of neoadjuvant therapies in patients with surgically resected non-small cell lung cancer with pathologic complete response.Journal of thoracic disease · 2026Article
- Real world comparative outcomes of adjuvant carboplatin versus cisplatin-based chemotherapy in stage IB-IIIA non-small cell lung cancer: a propensity-weighted analysis.Journal of thoracic disease · 2026Article
- Characterizing phantom lymph node collection during curative-intent resection of non-small cell lung cancer.The Journal of thoracic and cardiovascular surgery · 2026Article
- Lymph Node Dissection and Postoperative Complications After Lung Cancer Resection.JAMA network open · 2026Article
- Recommendation-adherent systematic lymph node sampling is not associated with increased complication rates in non-small cell lung cancer surgery-combined cardiothoracic center experience.Journal of thoracic disease · 2026Article
- What affects adequate lymph node harvest in pulmonary resections?-assessment of compliance with a national quality standard.Journal of thoracic disease · 2026Article
- Article
- Adherence to Postoperative Survivorship Quality Metrics in Early-Stage Non-Small Cell Lung Cancer.The Annals of thoracic surgery · 2026Article
- Outcomes Linked to 3N2+1N1 Sampling by Surgery Type: A Commission on Cancer Lung Cancer Quality Metric.Annals of thoracic surgery short reports · 2026Article
- Hilar Lymphadenectomy Is Associated With Improved Disease-Free Survival in Pathologically N0 Non-Small Cell Lung Cancer.World journal of surgery · 2026Article
- Optimizing Lymph Node Staging in Non-Small Cell Lung Cancer Surgery: Evidence, Guidelines, and Quality Improvement Strategies.Journal of clinical medicine · 2026Review
- Availability of multidisciplinary treatment modalities and outcomes among patients with resected early-stage non-small cell lung cancer.JNCI cancer spectrum · 2025Article
- Early compliance with lung cancer lymph node standard 5.8: An analysis of 2022 and 2023 Commission on Cancer site reviews.The Journal of thoracic and cardiovascular surgery · 2025Article
- Perspectives on Commission on Cancer Standard 5.8 on Lung Cancer: A Qualitative Study.The Journal of surgical research · 2025Article
- Occult Node Detection With Lobectomy Versus Segmentectomy for Stage IA NSCLC.JTO clinical and research reports · 2025Article
- Surgical consensus for screening, diagnosis, staging, multimodal management and surveillance of early-stage resectable non-small cell lung cancer (NSCLC) in Malaysia.Translational lung cancer research · 2025Review
- Surveying surgeon practices and perspectives on extent of intraoperative nodal evaluation in non-small cell lung cancer.JTCVS open · 2025Article
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
introductionThe American College of Surgeons Commission on Cancer recently updated its sampling recommendations for early stage NSCLC from at least 10 lymph nodes to at least one N1 (hilar) and three N2 (mediastinal) lymph node stations. Nevertheless, intraoperative lymph node sampling minimums remain subject to debate. We sought to evaluate these guidelines in patients with early stage NSCLC.
methodsWe performed a cohort study using a uniquely compiled data set from the Veterans Health Administration. We manually abstracted data from operative notes and pathology reports of patients with clinical stage I NSCLC receiving surgery (2006-2016). Adequacy of lymph node sampling was defined using count-based (≥10 lymph nodes) and station-based (≥three N2 and one N1 nodal stations) minimums. Our primary outcome was recurrence-free survival. Secondary outcomes were overall survival and pathologic upstaging.
resultsThe study included 9749 patients. Count-based and station-based sampling guidelines were achieved in 3302 (33.9%) and 2559 patients (26.3%), respectively, with adherence to either sampling guideline increasing over time from 35.6% (2006) to 49.1% (2016). Adherence to station-based sampling was associated with improved recurrence-free survival (multivariable-adjusted hazard ratio = 0.815, 95% confidence interval: 0.667-0.994, p = 0.04), whereas adherence to count-based sampling was not (adjusted hazard ratio = 0.904, 95% confidence interval: 0.757-1.078, p = 0.26). Adherence to either station-based or count-based guidelines was associated with improved overall survival and higher likelihood of pathologic upstaging.
conclusionsOur study supports station-based sampling minimums (≥three N2 and one N1 nodal stations) for early stage NSCLC; however, the marginal benefit compared with count-based guidelines is minimal. Further efforts to promote widespread adherence to intraoperative lymph node sampling minimums are critical for improving patient outcomes after curative-intent lung cancer resection.
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