Comparing Nodal Upstaging Rates and Morbidity and Mortality of Common Nodal Sampling Guidelines in the STS General Thoracic Surgery Database.

Abstract

To compare nodal upstaging and morbidity and mortality (M&M) rates for Operative Standard 5.8 vs other nodal sampling guidelines. Patients who underwent clinical stage I-IIIA non-small cell lung cancer resection between July 1, 2021 and December 31, 2024, were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database. We evaluated nodal upstaging and M&M rates for Operative Standard 5.8, a modified European Society for Thoracic Surgery (ESTS) lobe-specific guideline, a lobe-specific guideline based on work from Japan ("modified Japanese guideline"), and a hypothetical "2+1" guideline (≥2 mediastinal and ≥1 hilar station sampled). Odds of nodal upstaging and M&M for patients who met each guideline vs no guideline were compared using multivariable logistic regression. Of 46,954 patients, 68.7% met Operative Standard 5.8, 32.4% met the modified ESTS guideline, 25.9% met the modified Japanese guideline, 83.9% met the 2+1 guideline, and 16.1% met no guideline. Nodal upstaging rates were 11.6% for Operative Standard 5.8, 11.7% for the modified ESTS guideline, 11.5% for the modified Japanese guideline, 11.5% for the 2+1 guideline, and 7.6% for patients who met no guideline. M&M rates were nearly identical across the 4 guidelines (5.2%-5.3%) and similar to those among patients who met no guideline (4.9%). Findings were consistent in multivariable-adjusted analyses. In the Society of Thoracic Surgeons General Thoracic Surgery Database, nodal upstaging and M&M rates were comparable between Operative Standard 5.8 and the modified ESTS, modified Japanese, and 2+1 guidelines, supporting similar performance of these nodal sampling strategies. Upstaging rates were higher for patients who met any guideline vs none.