Adequacy of Intraoperative Nodal Staging during Surgical Resection of NSCLC: Influencing Factors and Its Relationship to Survival

Abstract

This study provides a much-needed benchmark of current thoracic surgical practice in lung cancer in the United Kingdom and important granularity to facilitate changes to improve adequacy of staging.

Assessment of adequacy of intraoperative nodal staging and factors influencing the lack of its compliance with recommendations in the surgical treatment of non-small cell lung cancer (NSCLC)

“…A noticeable growth in the number of evaluated parameters was seen from the year 2009, after the UICC recommendation to observe the practice of intraoperative staging in the Wroclaw Thoracic Surgery Centre. A similar upward trend with regard to staging adequacy (following the implementation of IASLC recommendations) is also reported to happen in one of the British centres (9). Creation of recommendations by scientific societies or research groups with regard to intraoperative assessment of lymph nodes is therefore legitimate, as it leads to improvement of N category staging quality.…”

Adequacy of intra-operative nodal staging during lung cancer surgery: a poorly achieved minimum objective

“…The patients with left-sided resections had significantly higher rate of inadequate LNS (1). The disparity between left and right concerned LN-stations 2, 4, and 7.…”

“…Edwards and coworkers (1) found that adequate LNS increased significantly from 14% in 2011 to 53% in 2014. All lung cancer resections had been performed by five dedicated thoracic surgeons.…”

“…Edwards and coworkers (1) found that there was no difference in survival between patients with adequate versus inadequate intra-operative LNS and when survival was stratified according to overall stage, a wide spread knowledge possibly favoring tendency to lessen LNS. However, they found better survival for pN2 patients with adequate sampling.…”

“…Median pT size was 1.5 cm in each group. Video assisted thoracic surgery (VATS) resections are also reported to be associated with less complete intraoperative LNS(1,17). Martin and coworkers (18) reviewed 2830 NSCLC, of whom 1964 had open thoracic (OT) procedure and 500 VATS resections.…”