Research Highlights Need for Expanded Lymph Node Assessment

New research presented at the 2026 Society of Thoracic Surgeons Annual Meeting indicates that additional lymph node evaluation is necessary during surgery for non-small cell lung cancer (NSCLC) to accurately identify cancer spread.

Current Practices and Study Findings

Surgical standards regarding the number and location of lymph nodes removed for metastasis assessment in clinically node-negative NSCLC vary globally. In North America, 2021 standards recommend assessing three N2 nodes and one N1 node.

The study suggests that more than one N1 node should be removed and evaluated. Data from the STS General Thoracic Surgery Database (GTSD), North America's largest clinical thoracic surgical database, revealed that more cancers were identified in N1 nodes than N2 nodes, with many located in N1 nodes adjacent to the bronchi.

Implications for Patient Care

According to study author Christopher Seder, MD, a thoracic surgeon at Rush University Medical Center, these findings aim to improve techniques for lymph node dissections, thereby increasing the chance of identifying cancer and potentially improving survival rates.

Expanded node dissection is expected to lead to the identification of more patients with cancer spread, allowing them to receive appropriate systemic treatments.

Dr. Seder emphasized that both surgeons, by dissecting more lymph nodes, and pathologists, by thoroughly evaluating lung specimens, play a role in this process.

Study Methodology

The research involved a review of 48,779 clinically node-negative NSCLC patients. The study found that 11.2% of these patients were upstaged following surgery, indicating their cancers were more advanced than initially assessed. Patients received various surgical procedures between July 2021 and 2024 across 279 centers, with data sourced from the GTSD. Patients who received neoadjuvant therapy, preoperative mediastinoscopy, lacked preoperative PET-CT imaging, or had incomplete pathologic data were excluded from the study.

Role of the GTSD

The GTSD, a component of the STS National Database, serves as a national benchmark, collecting comprehensive data on patient characteristics, surgical procedures, and outcomes. The study demonstrates the utility of large-scale data analysis in informing clinical practice.