An evaluation of lymph node harvest in sublobar resections in a statewide quality collaborative.

Abstract

Evaluate the effectiveness of nodal harvest in sublobar resections for peripheral non-small cell lung cancer. Retrospective review of prospectively collected data for patients who underwent wedge resection (WR) and segmentectomy (SG) for non-small cell lung cancer from January 2015 to March 2023 at 21 centers within a statewide quality collaborative. The primary end point was the extent of lymph node (LN) harvest defined as ≥10 LNs, ≥5 LN stations (LNSs), or 3 mediastinal LNSs and 1 hilar LNS (3/1 LNS). We also examined the LN harvest stratified by operative approach (open, video-assisted, or robot-assisted). A total of 1398 patients receiving sublobar resections were reviewed: 919 (65.7%) with WR and 479 (34.3%) with SG. Only 15.6% (152) WR and 54.6% (263) SG had an adequate number of LNSs harvested. Robot-assisted thoracic surgery was associated with higher rates of harvesting ≥10 LNs (P < .001) or harvesting ≥5 LNSs or 3/1 LNS (P < .001) compared with video-assisted thoracoscopic surgery for WR. Compared with open procedures and video-assisted thoracic surgery, Robot-assisted thoracic surgery was associated with higher rates of harvesting ≥5 LNSs or 3/1 LNS for SG (P = .002 and P = .003, respectively). WR and SG have low rates of adequate LN harvesting. Robot-assisted surgery was associated with improved LN harvesting rates. Given the increase interest in sublobar resections, continued focus on improving and increasing LN harvesting are needed.