Comparing Nodal Upstaging Rates and Morbidity and Mortality of Common Nodal Sampling Guidelines in the STS General Thoracic Surgery Database.
[BACKGROUND] To compare nodal upstaging and morbidity and mortality (M&M) rates for Operative Standard 5.8 versus other nodal sampling guidelines.
APA
Potter AL, Wang D, et al. (2026). Comparing Nodal Upstaging Rates and Morbidity and Mortality of Common Nodal Sampling Guidelines in the STS General Thoracic Surgery Database.. The Annals of thoracic surgery. https://doi.org/10.1016/j.athoracsur.2026.03.043
MLA
Potter AL, et al.. "Comparing Nodal Upstaging Rates and Morbidity and Mortality of Common Nodal Sampling Guidelines in the STS General Thoracic Surgery Database.." The Annals of thoracic surgery, 2026.
PMID
41933779
Abstract
[BACKGROUND] To compare nodal upstaging and morbidity and mortality (M&M) rates for Operative Standard 5.8 versus other nodal sampling guidelines.
[METHODS] Patients who underwent clinical stage I-IIIA non-small cell lung cancer resection between 7/1/2021-12/31/2024 were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). 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.
[RESULTS] 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 four guidelines (5.2-5.3%) and similar to those among patients who met no guideline (4.9%). Findings were consistent in multivariable-adjusted analyses.
[CONCLUSIONS] In the STS GTSD, 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.
[METHODS] Patients who underwent clinical stage I-IIIA non-small cell lung cancer resection between 7/1/2021-12/31/2024 were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). 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.
[RESULTS] 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 four guidelines (5.2-5.3%) and similar to those among patients who met no guideline (4.9%). Findings were consistent in multivariable-adjusted analyses.
[CONCLUSIONS] In the STS GTSD, 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.