Tim Edwards1, Haval Balata2, Mohamed Elshafi1, Philip Foden3, Paul Bishop4, Eustace Fontaine5, Mark Jones5, Piotr Krysiak5, Kandadai Rammohan5, Rajesh Shah5, Philip Crosbie2, Richard Booton2, Matthew Evison6. 1. Manchester Thoracic Oncology Centre, University Hospital of South Manchester National Health Service Foundation Trust, Manchester, United Kingdom. 2. Manchester Thoracic Oncology Centre, University Hospital of South Manchester National Health Service Foundation Trust, Manchester, United Kingdom; The Institute of Inflammation and Repair, The University of Manchester, Manchester, United Kingdom. 3. Department of Medical Statistics, University Hospital of South Manchester, Manchester, United Kingdom. 4. Department of Histopathology, University Hospital of South Manchester, Manchester, United Kingdom. 5. Department of Thoracic Surgery, University Hospital South Manchester, Southmoor Road, Manchester, United Kingdom. 6. Manchester Thoracic Oncology Centre, University Hospital of South Manchester National Health Service Foundation Trust, Manchester, United Kingdom; The Institute of Inflammation and Repair, The University of Manchester, Manchester, United Kingdom. Electronic address: matthewevison@hotmail.co.uk.
Abstract
INTRODUCTION: Adequate intraoperative lymph node sampling is a fundamental part of lung cancer surgery, but adherence to standards is not well known. This study sought to measure the adequacy of intraoperative lymph node sampling at a regional Thoracic Surgery Centre and a tertiary lung cancer center in the United Kingdom. METHODS: This retrospective study analyzed the pathological reports from NSCLC resections over the 4-year period 2011-2014. Adequacy of sampling was assessed against International Association for the Study of Lung Cancer recommendations of at least three mediastinal lymph node stations: station 7 in all patients, station 5 or 6 in left upper lobe tumors, and station 9 in lower lobe tumors. The influence of clinical variables (age, tumor T stage, type of surgery, and laterality) on adequacy of sampling and the effect of adequacy on overall survival were also assessed. RESULTS: A total of 1301 NSCLC resections were performed from January 11, 2011, to December 31, 2014. Adequate intraoperative lymph node sampling increased significantly from 14% (22 of 160) in 2011 to 53% (206 of 390) in 2014 (p = 0.001). Secondary analysis of clinical variables also revealed that patients with T1a or T4 tumors, those undergoing sublobar resections, those undergoing video-assisted thoracic surgery resections, and those undergoing left-sided resections have significantly higher rates of inadequate lymph node sampling. Overall, there was no statistically significant difference in survival between patients with adequate versus inadequate intraoperative lymph node sampling or when survival was stratified according to overall stage. There was worse survival in inadequate sampling for patients with pN2 disease than for patients with pN2 disease and adequate sampling. CONCLUSION: 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. Crown
INTRODUCTION: Adequate intraoperative lymph node sampling is a fundamental part of lung cancer surgery, but adherence to standards is not well known. This study sought to measure the adequacy of intraoperative lymph node sampling at a regional Thoracic Surgery Centre and a tertiary lung cancer center in the United Kingdom. METHODS: This retrospective study analyzed the pathological reports from NSCLC resections over the 4-year period 2011-2014. Adequacy of sampling was assessed against International Association for the Study of Lung Cancer recommendations of at least three mediastinal lymph node stations: station 7 in all patients, station 5 or 6 in left upper lobe tumors, and station 9 in lower lobe tumors. The influence of clinical variables (age, tumor T stage, type of surgery, and laterality) on adequacy of sampling and the effect of adequacy on overall survival were also assessed. RESULTS: A total of 1301 NSCLC resections were performed from January 11, 2011, to December 31, 2014. Adequate intraoperative lymph node sampling increased significantly from 14% (22 of 160) in 2011 to 53% (206 of 390) in 2014 (p = 0.001). Secondary analysis of clinical variables also revealed that patients with T1a or T4 tumors, those undergoing sublobar resections, those undergoing video-assisted thoracic surgery resections, and those undergoing left-sided resections have significantly higher rates of inadequate lymph node sampling. Overall, there was no statistically significant difference in survival between patients with adequate versus inadequate intraoperative lymph node sampling or when survival was stratified according to overall stage. There was worse survival in inadequate sampling for patients with pN2 disease than for patients with pN2 disease and adequate sampling. CONCLUSION: 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. Crown